Unlocking medical frontiers: exploring interventional radiology’s impact

Episode Transcript

Recorded live from the Cook booth at SIR and featuring leading experts in the field of interventional radiology, discussing a wide range of IR-related topics. This is the Cook@ SIR podcast series.

Well, hi everyone. Appreciate you joining the podcast here today. My name is Pete Yonkman, I’m president of Cook Medical, and I’m honored to have as a guest, Dr. John Kaufman. And for the physician community, he needs no introduction, but maybe for others who don’t know John, he is a— I’m not sure how we describe this, John. We just call you a legend, do we call you— What do we call you?

Just one of the worker bees.

Well, you are currently at SIR, right?

Yeah, yeah, at the SIR annual meeting, which has just been a blast. I’ve been to I think about 30 of these at least. So been hanging around for a while. A lot of energy, a lot of excitement. Just a lot of old friends, a lot of new friends.

Yeah. One of the things you have obviously a long resume and biography, but one of the most impressive things I think are gold medals from both SIR and CIRSE, I think that says a lot about your passion for research, patients, and education. So I think that’s the best way to sum it up.

Yeah. Well, thank you.

Yeah. So I want to talk to you about a lot of things today, John, but maybe let’s start with a meeting like SIR. Why are these meetings important, not only for you as a physician, but just for the community of physicians? What does it do to help advance medicine? I don’t think people understand what these meetings about. They think they’re just some show where people go and talk about stuff. But what is it really that drives the advancement in medicine through the mechanism of shows like these?

Yeah, Pete, it’s a great question because these can be viewed as sort of boondoggles or people just getting together to have a good time. And really what’s happening are some of the basic things where people get together and talk to each other and exchange ideas in formal and informal ways. And a lot of times the informal exchange can be really valuable. You have the opportunity to walk up to somebody and ask them, “How did you do this? And what have you seen? With this particular problem what do you think?”

The exposure to all of the new technologies is just a unique experience. These really— the bigger meetings in which there’s so many of the manufacturers, small people, just startups, the bigger, strategic, and the legends, kind of companies. Just the ability to walk around and see all this new stuff gives you great ideas, great energy. And probably I think one of the most important things we bring in, at least to this meeting: a lot of students, a lot of residents. You get the new generation exposed to what’s happening, all the different things you can do in your specialty, particularly interventional radiology here, and get them excited. They get to meet people that they have just read about and they get to realize that “This is a real person. And wow, I think I could actually do this because that person’s a real person too.” So just a lot of things.

I’ve been to a lot of these conferences over the years, and what always struck me is when you go into the panel discussions or to people presenting research, it’s not as if everybody just sort of applauds and nods their head. There is a lot of real debate that happens at these, and you can see the making of knowledge and the making of people understanding, what works and what doesn’t. And there’s real debate in here. I mean, this is not just for the show, it’s real people discussing real issues and trying to advance medicine along the way.

Yeah, I mean that’s sometimes the best part of this is the scientific presentations, the early research, and then the questions that come from the audience. And it helps a lot of things. It helps everyone in the audience think about what are the boundaries, what’s new? It helps the investigators, the researchers, they get a question that they haven’t quite anticipated from someone in the audience. It’s part of the research and knowledge development process. So there’s a huge amount of that.

There are all the educational courses. You can come here and if you’re interested in getting involved in a new aspect of your specialty, often there’s a whole series of courses you can sit in and learn from. So that education component is huge. And everyone probably comes with a slightly different goal when they come here and yet in these meetings, but as you said, they’re really important. These are not just an opportunity to eat together and go out to dinner. I mean, that’s actually truly ancillary. And to be honest, most of us are so exhausted— Those are pretty short dinners, because you just want to go rest to get ready for tomorrow.

Yeah, that’s right. Well, one of the things I didn’t mention was your new role with us here at Cook as a chief medical officer, and I want to talk to you about that too. Well, let me start with this. Why? Why’d you do it, John? Why be a chief medical officer? You’ve done a lot of things in your career. What made you want to take that leap?

I think another way to put it, as my mother said, “Why do they want you?” I mean, what is it? So I think you get to a certain point in your career. I’ve been very involved, clinically involved in the professional societies. To be honest, until discussions started with Cook, had never really thought about the transition to industry. For me personally, I felt ready for a new challenge. One of the key components is the people you’re going to be working with and the culture, the group that you’re going to work with, whether it’s a company or organization or new hospital, and to me that was really critically important. And the culture at Cook, the culture that you continue to promote and emphasize, is so similar to how we approach treating our own patients, where you’re really putting quality patients first.

That part was a very easy transition for me. The opportunity to get involved in so many things, and not to be promotional just about Cook, but we are so involved in so many different areas. I think a lot of interventionalists don’t understand, there’s a huge endoscopy business, urology, critical care. We’re in a lot of different places, all of which intersect in some way with interventional radiology. But getting to really see it from the side of the gastroenterologist, urologist, it’s a very exciting, fun thing to do. So for me, it’s like being in a candy store. I probably shouldn’t tell my boss that, but it’s been great fun.

But I think to make some move like that, you want to just be really thoughtful about who are you’re going to be working with, what you’re going to bring. I mean, that’s a really important thing. It’s not just to come and have a title, but you really want to feel like you can contribute something to help move the organization forward and that you’re very aligned with the goals of the organization.

How many months into this, it seems like you’ve been a long time, but it hasn’t been that many months has it?

Yeah, eight months. Yeah.

Eight months. So what over that time has surprised you, not just about Cook, but about industry in general? Having seen on the other side of it now, what surprised you?

Yeah. I think what surprised me the most is really how thoughtful and serious everyone is about moving forward the products or the procedures in an incredibly safe, quality-based approach and really trying to understand what is best for the patients, how to work best for the physicians. The degree of thought that goes into it— the engineers are brilliant. There are just a lot of really smart people kind of thinking and moving things forward. And it’s very, very hard. And I think maybe if I had to pick the thing that’s most surprised me, it’s just how hard it is to get even the simplest thing from the bench into the hands of the physicians and the fortitude that’s required of everyone along the way to move that along.

Yeah, it is a very challenging industry in that regard and for reasons that a lot of people got to understand, it’s highly regulated, which of course it should be because of the nature of the work we do. But given that, and given that every country has their own regulations and has their own approach to things, it sometimes makes it a challenge to move projects forward, as you say. But I do think it’s one of the things I worry about, to be honest. I think about the startup of Cook and how the early years of innovation at Cook and how fast we were able to progress medicine, I do worry that smaller companies are going to have a harder time navigating some of this because it is so complex. There’s so much to do that is years in the making. And so you have to have quite a bit of funding now to be able to do something like a startup medical device company.

Yeah. And walking around here, there are a lot of startups and small companies, and I think that maybe the flip side of that is I think, oh, they only have to worry about one thing.

That’s true. One product.

They have just one product, one thing, and that’s all they have to do. Whereas we just have so many different products and so many different needs to address and so many different patients that we can touch. So different challenges depending on your size, I guess.

What are you excited about most? So you’ve been involved in a lot of new technologies over the years. What excites you the most? And what are you seeing in medicine? It doesn’t have to be Cook related, anything at all. What are you thinking of the next wave of improvement in patient care?

So globally, I think in medicine in general, I think we are definitely getting to very patient-specific, genetically specific, proteomic-specific therapies, whether it’s things that we do or combination procedures that we’ll do. So I think that is still a real thing and a real goal that therapies can’t, understanding that a cancer in one person with the same label is not the same cancer in the other person, and that same cancer in their body may be different in three different locations.

So I think we’re really getting to the point where we’re going to see some major breakthroughs in how we can tailor therapies. And instead of being in a situation saying, “This drug works for 80% of the people,” understanding why the other 20% needs something different, and being able to provide that. In our branch of the world with devices, I think we are just thinking globally about things in the sense of it’s not just about how do I best treat this lesion, but how do we impact arterial disease, venous disease with these devices? Not just prop open a lesion and keep it open for a certain amount of time, but the whole patient course, either getting to the point of needing intervention or following up the patient. I think that’s a really healthy change in the procedural specialties. And we’re just seeing this kind of grow into all the different areas as we expand.

Getting even more narrow in the interventional world, you walk around this room, the procedures that we’re seeing, the targets of therapy, the things that we weren’t even thinking about 20 years ago, 10 years ago, even five years ago, they’re now devices being developed for this. Embolization just keeps growing and the applications keep growing. And really advanced guidance systems and how to do procedures and how we can monitor our interventions. We’re working on the interventional MRI, which I think is really incredibly exciting. There was a presentation last night to the residents and medical students during our sponsor, the Synergy Dinner on iMRI, and you should have just seen these young people look at this and think, “Wow! I mean, that is really cool,” and “I understand why you have to be really good at imaging and you can see these things and do it without radiation,” and all these— They were just off running in their minds as to— and I said, “Well, by the time you’re done training, it’ll be available.”

Let’s talk about that for a second. So describe for folks who may not know, what is iMRI and how is it different than what procedures are today?

Yeah, so I think the very earliest procedures were all under radiation, live radiation. And that’s the key thing is live. So you could watch your procedure, watch things happen under radiation. I’m actually sitting underneath a photograph of Charles Dotter and Bill Cook, that famous photograph at the RSNA, and it says, “Needles and catheters and guide wires.” And that was kind of it.

As obviously this has grown, we now use CT to guide things, we use ultrasound to guide things. But there are things that are required to do these procedures that sometimes make it a little harder than easier for any radiation-based procedure. There are the radiation issues. Ultrasound is very dependent on whether or not ultrasound will work. So MRI has the ability to look at tissues and create— every piece of tissue becomes like a radio antenna, and by how you sort of tickle the tissue and the signal that it emits gives you the ability to really differentiate beautifully, very small structures, the composition of structures to identify very subtle differences in water content, which can then be related to pathology.

The problem has been they’re really big bulky machines. They have a long tunnel. If anyone has been in one for procedure, you feel like you’re going into a torpedo tube, and there’s a lot of noise. So we’re collaborating with Siemens. They have an open magnet, a lower field magnet but that’s open that gives you the opportunity to have better access to the patient. And we have been developing imaging sequences that are live fluoroscopic or live ultrasound. So rather than move the patient in and out to reposition the needle back, put it back in, see is it in the right place or not, you can really very— under direct vision see what you’re doing.

Now the problem for the last 20 years of—because this is not a new idea—has been the tools as well as the imaging. So the imaging part is looking really good, and we’ve also worked on and developed tools that you can see clearly. So instead of getting a lot of artifact or being invisible within the magnetic field or distorting it, you can see very clearly tools. And so you can now target very small structures, move catheters around inside blood vessels. So really pretty exciting. And I think when this came up on the screen to all the residents and medical students—basically our future practitioners and future generation—it was pretty clear to them that, “Oh, this is going to be something that will be really helpful.”

One of the things I don’t think that people realize if you’re not in the medical field, you don’t realize that as a physician you’re using X-rays all day long. You’re using radiation all day long to see what’s going on in your patient. So you try to limit the exposure by wearing lead aprons and things like that, but you’re still getting a lot of exposure for the caregivers who are in the room. As a patient, you’re getting very minimal because you’re only there for a short amount of time, but you guys are there all day long. So that is a concern I think, especially for younger people who are thinking about a whole career here: do I want to have this exposure to this radiation?

Yeah, I think it’s the radiation and to be honest, all the equipment is getting better and better and the doses are going down and going down and going down. You still have to wear lead. And I think one of the things, the little light bulbs that go off in everyone’s head is, “Oh, you don’t need to wear lead to do this procedure.” So that becomes a potential advantage. Something that to prove scientifically will take some time, but certainly to the immediate operator, “Oh, I can just run in and out or stand next to the machine and not have to wear this heavy lead all day.” That’s definitely going to be an advantage.

There’ll be still a lot of procedures that we’re going to want to do the same way with ultrasound and CT and fluoroscopy. I think this is actually going to give us access to do things we haven’t been able to do. So it’s not going to be purely, “Oh, let’s take these 10 procedures that we’re doing right now in x-ray and move them in there.” I think we’re going to be able to see things we haven’t been able to see before and allow us to treat patients and do things that we just actually haven’t been doing, because we’re saying, “Well, can’t see it now. Let’s wait three months, let this grow bigger, and then we’ll be able to see it.”

Yeah, that’s something I’ve heard doctors talk about is that you can detect a cancer or a potential lesion, you’re not sure if it’s cancer or not, but it’s too small. So today you really can’t get to it so you say, “Well, let’s just wait and see if it grows.” Well, from a patient perspective, I think I’d rather know now— earlier, right? It’s got to be better to know earlier.

Yeah, I think nerve wracking to be told, “Well just go ahead and pretend you’re okay. In three months I might give you some really bad news.” And the whole time I’m waiting for the scan, they call that “scanxiety,” waiting for that next scan because you don’t know what the news is going to be.

Of course.

Yeah. So I think the ability to see things, target things, to use those MR imaging qualities—which are so totally different than ultrasound and x-ray—to identify things, I think it is going to open up a lot of procedures and pathologies that we have for now just been saying, “Well, we can’t do much about it, so let’s think about something else.”

Yeah, that’s what I’m excited about, that. I’m excited about our partnership with Siemens and our team has been working obviously for years to bring these tools, make them available. It sort of seems to me a little bit, you mentioned Bill Cook and Charles Dotter when they were just figuring out wire guides and needles and catheters. There’s a little bit of an element of that here I think, too. I’m excited to see five years from now when those residents and fellows have this in their hands and figuring out what they can do next with it. It’s not just about a needle anymore. It’s about how do we see something we couldn’t see before? How do we get to an area of the body? How do we treat something new? These things are always new and medicine’s hard, so it maybe it won’t work, but it’s worth trying because I do think it brings some patient benefit that we haven’t seen before.

Yeah, I think that’s so important. That spirit is so important because you walk through this hallway and there are a lot of things, just like you say, that five years ago we weren’t thinking about, but someone said, “I wonder if I can do this. I wonder if I can do that.” So just providing another tool, another platform that gives us that many more potential opportunities is huge.

And maybe it won’t work. I think there’s going to be a role, just when you think about even some of the simpler procedures that we just can’t do now ’cause we can’t see things. And if you walk around this hall, a lot of the sort of advances are in guidance: augmented guidance, fusion imaging, taking ultrasound and CT and mixing them together. So there’s a big focus on improved guidance. And this will be really, I think, a nice step forward for that fluoroscopic MR images with needles and ablation devices that you can actually see as you place them, I think is going to be really well received and lead to some of those things that you’re talking about where people are saying, “Oh, maybe we can do this.” And no one else has thought about it yet.

Yeah. Yeah. That’s the exciting part, I think, is always just seeing what people come up with and they have a new tool in their hands.

One of the great things about this specialty, yeah.

Yeah. Talk to me about interventional radiology. Give me your best elevator pitch. If you were talking to a student, a medical student, give me your best elevator pitch of why they should become an interventional radiologist.

Okay. Understanding that there may be people from every specialty listening to this, so I’ll tell you just what I tell the medical students, because—

I’m putting you on the spot, John.

Yeah. We’re constantly in recruitment mode. I just say, “This is the best specialty in the hospital because you see such a broad range of pathologies. You get to do all these very interesting advanced interventions. It is constantly changing. Five years from now, you’ll be learning something new, so you’re always learning something new. There’s always something you hadn’t thought of so there’s this continued excitement. Huge benefit to patients. Even the simplest things we do, just putting a drain in an abscess is actually hugely beneficial to a patient. So you can see that direct impact, but then you can also treat really complicated things. Cancers, very complex aneurysms. Things that would be really challenging to treat otherwise. And there’s tremendous flexibility. You may decide 10 years into this, I think I’m really getting interested in musculoskeletal intervention. You can take the skills that you have learned, the imaging skills, the interventional skills, the device skills, learn the content, and then sort of pivot to another kind of pathology or group of patients, which is really challenging in a lot of other specialties that are more sort of narrowly defined around a pathology or an organ system or a patient population.” So that’s my pitch.

That’s good. I’ll do it.

Do you want to sign up? Yeah.

Well, okay. So talk to me about this too. You talked to students a lot, right?

Yep.

Younger folks who are coming in the position. And we actually, obviously a lot of businesses are bringing in younger folks all the time, and I find the energy terrific, and the people are— They work differently, there’s no doubt. I mean, the way people think and the way they work from when I came in is very different. Do you see that in medical students? Sometimes people talk about, “Well, medical students don’t want to work as hard, or they don’t want the same level of productivity. They want a work-life balance.” And how do you think about all those things?

Yeah, I think you have to be really careful in this situation not to fall into the, “Well, back in the day when I was walking uphill both directions to school, this is what life was like.” Yeah, it’s a new world. And I think people are, in general, much more cognizant of the life-work balance in asking the questions, “Do I really need to put in 90 hours a week in order to be satisfied with my work, to be successful?” There’s some people that are going to do that anyways because it’s just their nature and then others that are going to be more focused. So I think it’s sometimes a challenge, and when you have grown up in a system where it was a point of pride to be up three nights in a row and still go to work the next day, to be in a system where someone says, “You know what? I was up all night. It may not be the best idea for me to be working all day today.” And to sort of realize that, well, that may actually be true.

So I think we see this a lot. All the specialties see this. I think it’s not just in medicine. I think it’s just in general, the workforce. It forces us to rethink things, accommodate and adjust and create an environment in which we can still get all that productivity and keep people happy and keep people coming back to work. But it’s definitely different. There’s no question.

It’s for sure different, but also you make a good point. I feel like it is really easy to fall into the trap of, “Well, when I was coming up, this wasn’t how it was.” But the tools that you and I used to navigate our careers, to think about how we did our work are just, they’re a product of the environment. And to think that those same tools are going to be the same tools that are going to work today doesn’t make any sense because it’s a different world, different expectations, but it does mean we have to try to adapt to find a way to make sure that we are getting people the right training and the right education in a way that fits with the modern world. That’s the hard part, I find.

Yeah, I mean, there’s going to be certain fundamentals. I think we learned in COVID that in-person human interaction is really important, that video interactions alone are not going to replace that. So creating a sense of community, opening up communication, getting to actually know somebody, it does require some personal contact at some point. So I think these things won’t change, and there will be just a certain amount of stuff you have to learn and certain amount of knowledge, certain skills you’re just going to have to acquire in order to do certain things.

Now, the way you acquire it, the amount of pressure is put on you to acquire them, that may change. But I think that’s important to recognize that, like you say, how we learn, the pace in which we learn, the environment in which we learn may change, but there’s still things to learn. One of the most refreshing things of all young people, and I think at one point I was probably one of those, is questioning dogma. And it’s always a little bit sort of uncomfortable and says, “Well, why is that true? Why do we do it that way?”

It’s because I said it was, because take my– trust me on it.

That’s how we’ve always done it. You say, okay, well open my mind and maybe there’s a new way to look at this.

Yeah, that’s true. I find that that’s true of myself. I was always asking why. I always asking, is there a better way to do this? And on the other side of it now you can get frustrated by it because, “Come on, we’re just, we need to go along.” But that’s the energy that drives you forward. You need that energy. If everybody’s going along just to get along, it doesn’t stop and make you question.

Yeah, and I think it’s really important to keep that mindset: I remember when I was asking those questions. And so it’s not necessarily a challenge to what we really want to do or what I want to do, these are really good questions. And just you always have to remember, like when you have children, you always remember, “Yeah, I was a kid once too. I grew up. I was okay. I survived.”

Yeah, that’s true. I always tell my kids that. I give them the spiel of how I had to ride my bike to school and walk to school, but it doesn’t seem to phase them at all.

No. That doesn’t really cut much water. Yeah.

No, it doesn’t. Tell me about the experience of treating patients today, too. Are they more educated? Do they ask tougher questions? Has that changed for you?

Definitely. I think there’s in general kind of a generation-based approach to that. So particularly with older patients that although are using electronic media, they’re using the internet a little less questioning. And I think that’s just a traditional kind of approach, to individuals that are looking at their own images and asking you, “Could you look at image number 10 from this sequence of my MR? Because I’m wondering what I’m looking at.” Making information available to patients really has changed the dynamic. I finished a clinic note and I signed it, it’s immediately available to patient. And as the patient is in there leaving, or if they go back to the waiting room, they can open up their electronic MyChart, access and read the note that we just kind of concluded. So you’re thinking very carefully about what you’re writing, but the patients are also then returning and saying, “I didn’t understand this.” So there’s a lot more communication.

My view on that actually is it’s a positive. I like it when someone has a family member in the room. There are two sets of ears and two people to hear or ask questions and think. And if a patient is asking me about something that they’ve seen or a note, I think they’re really, like they’re partnering. They’re interested in their care, they’re partnering, and we can have very open, very frank discussions, and I know we’re actually communicating. So I think in a lot of ways, although it can feel threatening, it can actually improve your bond with your patients.

Oh, it has to be better. Having been through the medical system myself or my parents or family members, you need an advocate there. You just do. There’s no doubt about it. Because information does get missed. It does get lost. And even with the best of intentions, any system isn’t perfect. And to be able to have people there who have transparency to be able to ask good questions, I think it’s got to be an overall positive for healthcare.

Yeah, we’re all under such pressure because of the finances of healthcare, how the hospitals are structured or clinics or outpatients. Unfortunately, volume, which means the number of patients you see, becomes very important. And so that everyone has that experience of, “Gee, I went in to see my primary care doctor and I had five minutes.” But why is that? It’s because there are external pressures that are making this happen. Hopefully, I think this is going to swing back. This is where AI may be of benefit to the medical profession to help address some of these needs and some things that could be screened and sort of evaluated pre a visit for you, and so you can have a more focused visit. But yeah, I think that’s an experience that we all have. And I think just what you said is you need an advocate for your loved one.

Yeah, I can see it a day not very far off where that advocate will be AI. So if you have all of your records, if you have all of your information, you ought to be able to feed that into AI, and it ought to give you questions you should be asking. That can’t be far off.

Yeah, I don’t think it would be far off at all. I think probably you could just go on now and ask ChatGPT, “What’s the differential for a thing in this place?” And it’ll give you a list that you can then take into your office, right? No question. I think you’re right.

Yeah. Hopefully the backend will be supportive like with the test interpretation screening, imaging. That these will be tools. There’s always a threat that AI is going to take over and replace the human element, but like very other tool, going back to the printing press, the radio, the internet, these hopefully become things that just enhance the job you’re doing, maybe free you up to do something else rather than actually completely replace you. I mean, there will be certain things that we’re doing now that AI is going to do better, but I don’t think they’re going to be the most fun things that we’re doing. I think there may be things that are—

Are there areas of medicine that are really concerned about AI that are going to replace my ability to do my job, or they’ll overtake the work that I’m doing today?

Yeah. I think diagnostic radiology, which is an area that I am very familiar with, has a lot of concerns that it’s going to basically relegate the human element to just the sort of being the Solomon, “Is this yes or no? Here are the abnormalities. Can you make a decision?” And not necessarily using the processing of imaging, sort of the pattern recognition that we’re— all radiologists are trained to do, to analyze an image and come up and identify there’s an abnormality.

But again, I think it would be probably disingenuous to say that humans are perfect, and the machines they have no way to improve our performance. So if you look at it more that way, how can it assist you? How can it make you better at your job? I think maybe it’s a little less threatening, but there are machines that’ll screen your retina for you and tell you whether or not you have diabetic retinopathy, and there’s no human interaction at all. You just sit down, it does it, and then it gives you the result, and there’s nobody overseeing that. So I think it remains to be seen. Certainly has everyone’s attention at this point. So I am not as worried as maybe I should be, but I think there’s going to be a role for people. Someone’s going to have to have their hand on the catheter, right?

Yeah. There’ll always be a role. I always think about it as, I think you said it well, it’s the things that maybe weren’t as value added as we thought they were, that some of that drudgery work can be done and then it frees us up to do the more value-added stuff. It frees us up to be more creative, more thoughtful, more strategic. I’m hopeful that’s what it will be.

Yeah, it can be an equalizer in a lot of ways. And when you think about educational opportunities for individuals, and we can’t all see the same thing. We can’t all train at the most prestigious institutions. And it could be that AI is going to really equalize a lot of us in terms of our ability to make certain diagnoses, manage certain patients. We’re always very concerned about equity issues in medicine; AI may in some way help address that by equalizing in certain ways people who have not had the opportunity to have the background training that maybe someone from a different pathway had. So I always try to look to the positive side.

You have access to all the information you want.

Yeah.

Now think about what to do with it.

Yeah.

Well, I know you have a lot to do here. I don’t want to take up all of your time, but this has been a great conversation. I want to end with one question for you. So if you could talk to our listeners about one thing, one technology that has changed medicine more than any other in your career, what is it?

Oh, a technology that has changed it or will?

Has.

Oh, has changed it?

Yeah. You’ve been practicing for over 30 years. What is something that—

Yeah, it’s the digitization of medicine for sure. Digital imaging, digital electronic charts, the digital information systems, absolutely change. So I guess I’m old enough to have been working in paper charts, walking around hospitals, digging through films. If I need to get to know a patient, reading through 200 pages of information. I think the digital revolution as applied to medicine, really has changed things completely. It has definitely made us work better, faster. One of the problems is we work all the time, but that’s more on us than the digital approach to things. But I think that would probably be it.

Well, for all of us who have access to healthcare, I just want to say thank you. Because I know, sometimes in the world there’s sort of this “big company” thing or “Big Medicine” or it was sort of this anti-science thing, but when you get sick or you’ve got a family member who’s sick, you need that hospital system to be really, really good. And most of the healthcare providers that I have met are there for the right reasons. They really want to help. They’re doing amazing work. And technology is advancing. So just say thank you to your and your colleagues for sticking that out and not listening to the chatter on the internet.

Now speaking just as a physician, without the devices, the support of industry for meetings and things like that, a lot of this just wouldn’t have been possible. So I would just go right back at you and say, we appreciate the partnership to help move forward and do better care for our patients and get more people into practice.

Yeah. Well, thank you, John. Have a great rest of your meeting at SIR, enjoy your time. I see you have a little bit of red on there in your handkerchief. Find Cook red.

Just a little bit. You can see my #FindCookRed button as well. So proud to wear it.

All right. Good to see you, John. Thank you very much.

All right, good to see you. Thanks.