EPISODE 385: The Favorable Research to Support Chiropractic with Shawn Thistle, DC

Hey, chiropractors. We're ready for another Modern Chiropractic Marketing Show with Dr. Kevin Christie, where we discuss the latest in marketing strategies, contact marketing, direct response marketing, and business development with some of the leading experts in the industry.

Dr. Kevin Christie: [00:00:00] All right. I'm excited to have Dr. Sean Thistle on the episode again, not the first or the last, and we're going to have a little bit of a kind of an update on the research and some other topics, uh, this, this particular episode. So welcome to the show. Tell us a little bit about the, um, the new world of Sean Thistle and what you've got going on.

Update our audience. This might be the first time they've heard of you. I doubt it, but, uh, what do you got going on?

Shawn Thistle: All right. Thanks, Kevin. It's nice to be back again and always good to chat with you. Uh, these days, um, as always, I'm up to a combination of, uh, helping chiropractors integrate, integrate research into their patient care and creating, uh, evidence based, uh, usable continuing education courses for chiropractors.

So for our colleagues down in the States, I'm a, I'm a PACE approved, um, continuing education provider. And so, you know, I practiced for a long time and then sort of transitioned into doing this full time because, you know, staying up on the literature is a full time job. And putting a clinical lens on things is [00:01:00] sort of what I specialize in.

And we offer a subscription based service with weekly research reviews that many of your listeners are probably familiar with. And the online, uh, continuing education offerings. And then the rest of my time where you and I bump into each other at chiropractic conferences, I'm on the, on the speaking tour and, and run my own events that way and do a bit of teaching at CMCC in Toronto and, um, medical legal consulting in chiropractic cases in Canada is kind of the other thing that I do to, to round out the week, you know,

Dr. Kevin Christie: busy, busy.

And we had a good time in Vegas together there. We had a little, Salon dinner, which, uh, for the folks out there that aren't familiar with that, just a conversational type dinner around a topic. There was eight of us that we kind of cherry picked and wanted to have, uh, diverse thoughts on the, of the profession.

And I thought that was fun and it was enjoyable.

Shawn Thistle: That was honestly, I appreciate the invite to that event. And it was one of the kind of, it was a cool format, first of all. And [00:02:00] I think everybody that was there, it's a way to get. A bunch of people together in kind of a collegial environment that may not have ever sat together and you realize how much you have in common with everybody.

And when you talk about the profession as a whole, only good things happen. And I thought that was really cool. So yeah, that was a really great event.

Dr. Kevin Christie: Yeah. I'll try to do another, another one next year. I'm not sure if I'll be in Vegas, but I'll do it, do it somewhere. And

Shawn Thistle: yeah,

Dr. Kevin Christie: it was good. I think the only thing I would change is get into a quieter environment.

Um, but that's going to be challenging at restaurants, right?

Shawn Thistle: Yeah. It, yeah, I know what you mean. It wasn't that bad though. I mean, it's, I've been in louder restaurants, so it could have been worse. Yes, for sure.

Dr. Kevin Christie: It was very good. Yeah. Very good. Very good. And then the other thing I wanted to thank you for is you've been a big help for our MCM, uh, clients and you're producing the slide deck material, uh, that we post for our clients on Instagram and Facebook.

And, uh, that's been very well received and kind of distilling down the research [00:03:00] into the, to the lay person to consume.

Shawn Thistle: Nice. Yeah. I'm glad. I think I'm always looking for different formats and, you know, when you came to me with that idea, I'm like, Yeah, it's like how, how much, how quickly can you boil down a study into three or four statements and get the point across and stimulate some interest.

And really, like you and I talked about, give our colleagues something to talk about with their patients or help inform patients about what we do at the same time. So, yeah, I like doing it that way. It's cool.

Dr. Kevin Christie: Yeah, it's been neat. And we've had some good feedback as far as what even our chiropractic members have learned by just getting them and reviewing them.

It's like, Oh, okay. I didn't know that that was out there. And I think that's something that I want to kind of roll into and segue is because, you know, it's like if you If you got arrested by the cops in Vegas for doing something you shouldn't be doing, but you didn't know that was illegal, that's not an excuse, right?

The police aren't going to buy that as a, as an excuse for the crime you just committed. And it's kind of the same way with research is that, [00:04:00] uh, as a doctor, um, it's part of your responsibility to know what's out there or coming out there. And if you don't know what the research is and you can't really just say, well, I didn't know that, uh, it doesn't, uh, it doesn't really line up too well.

And so I think, Uh, what you've done is Yeoman's work to really try to educate, uh, the chiropractor on what is the research saying? What's, uh, what, what do we feel really strong about? What are we looking forward to over the next six months or the next year? Um, around that. And so what, what are some of the things you're seeing in the research that you're, um, excited about?

You still got some interpretation to figure out with that. I love the fact that you had a clinical background. In practice and you, and you've been in the trenches and so you can apply it to that. So what are some of the things you're seeing?

Shawn Thistle: Well, I think, you know, the, the, the responsibility to stay current on research is not a uniquely chiropractic problem.

If you're a physical therapist or a cardiologist or whatever your [00:05:00] specialty is. There's some obligation that comes along with being a doctor that you're, you're, you're current on what's happening and the average clinicians ability and willingness, I think, to stay current on the evidence is are both challenges now, because people are busy with their practice and, and, you know, you do a great job dealing with all the aspects of practice on your, your podcast and everything you do apart from knowledge transfer, but knowledge transfer takes time.

It takes some awareness of what the, what kinds of evidence there are. And I would suggest that there's a, there are a couple of issues. Now, there's a volume issue of science that's coming out. When I first started. Reviewing papers for a subscription based service. I was concerned that I wouldn't have enough papers to review 1 per week.

And now, literally, I can do 50 a week and not cover everything. So my job is to help. Identify a variety of different topics that clinicians might be interested in, and not like, low back pain all the time, or something that people might get a bit [00:06:00] bored with, but also help them understand the sort of 30, 000 foot view of evidence and what things are happening and where things are shifting.

So to your question. I think we've, we've made a transition as a profession, and it's, it's partly because of different sources of big data that are available to us now. Like, you have to remember evidence based medicine wasn't a thing until the mid nineties really, uh, randomized trials weren't conducted and until the 1920s or 30s, and they were conducted poorly without much ethics approval and all kinds of problems with it.

But the model that we've always been trying to fit ourselves into as a profession in the last 30 years is pretty new. And we, we've gone from trying to show people that we can conduct the randomized trials and fit into the evidence based pyramid and do what we can to having access to huge databases of real world data of how chiropractors are helping people, uh, you know, in clinical practice all across the United States and North America and in [00:07:00] Europe, for example, and how, you know, the impact that we're having on patients live.

So I think the need for good. High quality, well designed, randomized trials is still there, but I feel like that's being supplanted a little bit by our access to big data, which taken as a collective can show us the impact that chiropractic can have from a cost saving perspective from helping back pain patients avoid opioid prescriptions, benzodiazepines, gabapentin.

I have a review coming out this week on Robert Traeger's new paper about tramadol prescriptions. And how seeing a chiropractor for radicular low back pain can reduce the chances of being prescribed tramadol. And we just didn't have this stuff before. And I don't think we would have pulled this info out of a randomized trial, but when we see what's happening in the real world via insurance data, or however else you can access it in these big databases, there, there are a couple of things.

There's power at scale and the answers are so consistent. They become hard to argue with, even if there are some drawbacks to that [00:08:00] methodology. And I think That's a major shift that that we have to sort of ride the wave of, um, until it sort of shifts again. But I think the narrative around chiropractic care and the impact we can have for patients has shifted more in the last 5 years than it has in the last 30.

And I think that's a powerful thing to to embrace for us. But as you said, it's a matter of. You know, the clinicians knowing what to talk about when they meet MDs or when they meet new patients and have how we network around that and how we integrate our knowledge into actionable things that we can do with patients, referral sources, third party payers and that sort of thing.

So there's still a lot of work to do, but I think, you know, I've talked to a couple of conferences about. You know, do we need more randomized trials on chiropractic manipulation versus exercise for back pain? I don't think we do. They're both clinical guideline recommended treatments. 1 is not necessarily better than the other, but via these big databases, we might be able to pick out.

[00:09:00] when and who would respond better to manipulation or exercise at a different time based on maybe what kind of back pain they have. And the Danes are doing a lot of good work on back pain trajectories now. And I think in the next few years, they're going to help us elucidate seven or eight different types of back pain that people have.

And with. Income in combination with some bigger data there, we might be able to start algorithmically pointing a certain type of back pain to a certain type of treatment. I think that's going to be a golden road for us. If we can figure that out, because that will help the average clinician understand what to do with a patient in their office on Monday morning.

So there's sort of a lot of things happening, but I think the main shift in the last few years has been Is from, you know, randomized trials with 50 patients per group to looking at databases with 115 million people. Like, I'm not sure, you know, you can't compare the impact of 1 to the other anymore. Plus, randomized trials are super expensive to conduct.

Um, [00:10:00] there are even the best design trials are still open to criticism and look, database papers are not perfect either. But geez, they keep telling us the same answer over and over and over again at scale. So I think they're becoming harder to argue with. So that's sort of where I sit on what the shift is.

And it's, it's really exciting to see. And I think what's nice about it is that these results and the impact that they can have on patients are almost a direct reflection of what all of us have seen in practice and what all of us have been waiting for the evidence to tell us. So I think We're entering a really good time period for chiropractors in terms of how we integrate and consume evidence.

Cause it's all lining up pretty well for us at this point.

Dr. Kevin Christie: Yeah, it's pretty cool. And you mentioned big data. I was just at a Jay Greenstein's event in DC and he talks a lot about data as well. Um, based on like what you're talking about, they're looking at even from insurance carriers and competing with them.

And so you're seeing the, the, the data. Really be able to tell [00:11:00] stories in different aspects of the profession. It's excited to be able to leverage that. And, and obviously our, our ability to, um, aggregate and accumulate all that data is getting better and better, which is pretty cool. Are you seeing anything with AI that's helping with, with that, uh, currently down the

Shawn Thistle: road?

In some ways, I'm, I'm the wrong person to ask about AI. That's, that's a J, that's a J thing to talk about, um, as you know, but I think, you know, from a, from my perspective, AI presents a couple of challenges. One is that in some places. These sorts of tools are being used to like mass produce research and it's getting harder in some areas to tell what's real and what's not, but that's a knowledge transfer problem.

I think the power in the AI is going to come in the coming years anyway, in helping us crunch all this data and figure out what's what and come up with these algorithms that might be able to help us in [00:12:00] clinical practice and even identify. Some relationships and other things that we may not have even known were there.

So, you know, I, I think there's a, there's a broad, uh, positive possibility for it, but just like any other application of AI, we just have to navigate it carefully, I think.

Dr. Kevin Christie: No, it makes sense for sure. Um, one of the things I've, I've been, uh, I think a subscriber for three or four years now of your service and what I liked, there's a lot of things.

Um, it definitely helps me keep up to date on certain things, but you'll break it down because then, you know, a lot of times when you, when you're When someone says chiropractic, like, what does that mean? But you'll actually like tease out, you know, spinal manipulative therapy is showing this, and you'll even say, sometimes I see some things on dry needling sometimes and an exercise.

And, and so you, you, you don't just lump it into things and you really carve out what you're seeing. And it helps me as a provider, um, connect the dots or, you know, when something. Like we just had in the state of Florida, actually, um, dry needling. We're allowed to [00:13:00] do now as chiropractors without doing the acupuncture training, which is a big deal for us.

It's it was a big battle just got signed in last week. And I've been able to keep up with like, I mean, a lot of us know this, but I was keeping up with like, what can dry needling do? What's what's the whole. In what we're, uh, offering or in what we're seeing in our patients that we're not getting results in, uh, and what could that fill?

I'm an evidence based model. And so I've, I've always appreciated that. Yeah. And one of the things I did notice is that spinal manipulative therapy has a lot of, a lot of benefits. Um, I think it's, it's becoming pretty apparent. Uh, what are your, what are your, some of your updates on, on that?

Shawn Thistle: Yeah, 1 of the 1 of the things that I put together this year was a 5 hour seminar, like a video based course you can take on my platform with Dr Simon Wang from CMCC.

He's spoken at Parker events in the last few years. So some of your listeners may have seen [00:14:00] Simon. And we put a course together about the mechanisms of action of spinal manipulation and looked at the data and the science on physiological changes, immunology, biomechanics, um, all the way through to contextual factors and kind of the qualitative stuff that might impact treatment response.

And, you know, the, the ultimate punchline from that course is the, the, the, the effects of spinal manipulation are probably. Pretty broad in terms of where they come from. And I think ultimately down the road, maybe 1 mechanism applies more to 1 patient than another. Like, maybe it's the modulation of the pain generating system in 1 patient.

Maybe you're reducing a region of spinal stiffness that was generating some nociceptive signals in another. Uh, maybe some patients feel better over time because they're their immune system responds differently to spinal manipulation and responds well. And for some patients, maybe it's just the act of coming into your office and they love seeing Dr.

Kevin. And I think [00:15:00] we shouldn't stress too much about the mechanisms. It's kind of like geeking out on what manipulation does. And that's why we put the course together. It's been very popular course so far. Because of course, chiropractors are interested in this, but I think, you know, I think The profession has survived over over time in the absence of evidence, because we provide an intervention that patients find helpful.

I think the evidence is going to help us fine tune how we apply that intervention. And I think it's equally as important to know who to adjust. Just like it's important to know who not to adjust. And I think. Once we figure out the nuances there and start to apply it in clinical practice, I think chiropractors have a pretty good batting average overall, in terms of patient, uh, successful outcomes, patient satisfaction and that sort of thing.

But if we can make that even better, the argument for us at a system level in the health care system at large becomes a lot more compelling. And so I think that's, we have to continue to dive into the mechanisms [00:16:00] that way, but also recognize that. We can't define ourselves as one intervention. Seeing a chiropractor and seeing a chiropractor that takes time to do a lot of detailed history and communicate with you and talk to you and empathize with you and be a source of information and comfort and, you know, Support.

I think all of those things are important. And as we see that kind of qualitative literature emerge over time, it's again, just backfilling what we already knew is that, you know, it's something around the whole health care experience that chiropractors provide that's magical for patients. And I think we shouldn't.

be so eager to attribute it directly to the treatment we provide all the time and be open to the fact that it might be some other things. So I may have strayed a bit from where you're

Dr. Kevin Christie: is perfect. You know, cause there's a, it's multi layered for sure. I just think I've noticed a lot from the evidence based chiropractors and some of them are straying away [00:17:00] from spinal manipulation altogether.

And if that's their personal choice, that's fine. And they may be heavy into. Muscle work or heavy into, uh, you know, rehab, exercise, things like that. And I know all that's fine, but I think some of them might just have a void also in, in what the research is saying about the benefits of spinal manipulative therapy therapy.

And so that's not why they're doing it. Or they, frankly, I see some of them, they just, um. They never really put in the hours and efforts to get good at it. So they're not seeing the results of it because it's maybe not a great adjustment being delivered. Uh, so there's a lot of nuances to that, but I just want to make sure that whatever direction the chiropractor wants to go in the services they offer their patient, I'm fine with as long as it's an evidence based realm, but don't throw out spinal manipulative therapy because you don't think it's actually, um, We're, you know, what the, the, [00:18:00] the efficacy is not there or something.

Right. Like it's, it's there. Definitely. And I, and I think it's important for them to know,

Shawn Thistle: and it's, you know, it's maybe we're getting to the age where we're talking about the generational thing, but the fact of the matter is manual therapy is a learned skill over time. And I think what, what I've seen in the real world is that some graduates come out and they're frustrated that they're not as good as the seasoned veteran doc that they start working with, but it's not reasonable to think that you're going to be the same there.

And you've, you talk about developing young chiropractors and we talked about that at the salon dinner too. And, and it's, you know, wanting to, to achieve early in your career, there's nothing wrong with that. You still have to be realistic with yourself about your experience level, how many humans you've had your hands on.

And I think from a, from a 30, 000 foot view perspective, our ability to provide, um, empathetic, comprehensive manual therapy will be a strength of our profession going forward. As medicine [00:19:00] evolves away from touch and personal human interaction with patients as AI starts to weave its way into medicine too.

So, you know, um, there, there's, there's a lot of value clinically and a lot of power in human touch in a healthcare environment. And I think that alone is a reason to continue with manual medicine provided that it's given in. Conjunction with other evidence based treatments and you make those decisions in conjunction with the patient.

I mean, there are so many ways to integrate it. Well, I think abandoning it. And I know what you're saying. I've seen it online too is, you know, there's, there's some frustration with, I think, skill level, so they don't necessarily see the results that they want. But. Again, they've come out of chiropractic school thinking they're going to know everything they ever want to know, and there are lots of avenues.

Like, I'm not a technique guru, but if someone wants to get better at their manual skills, they could go to MPI, for [00:20:00] example, in the United States. Those guys do amazing work and help people fine tune, uh, what they do. And so I think. We have to impart on our new grads the idea that you're at the beginning of your journey, not at the end of it.

And that includes financially, skill wise, uh, cultural authority wise and confidence wise. And it's up to the rest of us who are in practice that work with the younger docs to help bring them along. And I think that's something you focus on a lot through the work that you do. So it's, it's really important to do that.

Dr. Kevin Christie: It's, I'm so glad

Shawn Thistle: you

Dr. Kevin Christie: brought that up. It's really pure gold there. And it's, you know, you have that, you have to have that growth mindset and try to work towards mastery. Cause it's not going to happen overnight. And I think what's happening is certain things, the learning curve is not as steep, right? Like no offense to these things I'm going to say, but Exercise and doing exercise with patients is great and phenomenal.

The learning curve is not as steep as say manipulation, palpation, manipulation, dry [00:21:00] needling. You can, you can get that in a weekend and do dry needling on Monday. The learning curve is not as steep. Uh, kinesio taping, laser therapy, right? Like you name it, a lot of those things don't have a deep, steep learning curve.

Whereas palpation manipulation does, and I'm afraid that too many of the newer DCs coming out are, are, you know, not overcoming that obstacle as Ryan Holly was holiday would say, and they're kind of going to the path of least resistance. And then almost in defense of it. Is saying, well, manipulation doesn't work and it's overrated like all those things to feel better about it.

I'm not saying everybody does it, but I do see that happening a little bit. I do think I do think they need to hit it head on and just say, you know what? Yeah, I'm 26 years old graduating. I'm probably not going to be a skilled hands on palpation manipulation. chiropractor until I'm 30 or 31, or maybe it's 27, whatever it is, but it's going to take some time and you got [00:22:00] to embrace the suck a little bit sometimes.

Shawn Thistle: Yeah. Yeah.

Dr. Kevin Christie: Because on the other end of that is another 30 years of phenomenal practice and benefiting patients. And I think, yeah, I'm so glad you, you brought that up because it wasn't a direction I was necessarily thinking and it's just really spot on.

Shawn Thistle: Well, there are two, two simple facts there and one simple fact is you remember being a chiropractic student.

Who do you primarily work on when you're learning

Dr. Kevin Christie: classmates

Shawn Thistle: who are all young fit people, right? Walk around any chiropractic campus. It's a bunch of young fit people. And then when you get into practice, who are your patients? Like old stiff people, I'm generalizing, but, you know, and all of a sudden, you've got a body type on your table that you don't have much experience with.

And so give yourself some grace to learn. And then the 2nd thing I tell young practitioners is if you move to a small town in Ohio or Ontario or wherever you are, call the oldest chiropractor. In the in the town and go and get [00:23:00] adjusted by that chiropractor and you'll see how amazing they are and and then you'll know what your delta is from where you are to where you need to be.

And so, you know, I don't think we leverage that natural mentorship stream that kind of. You know, our chiropractic colleagues have a history of eating their young instead of supporting them. And I know you help people try and navigate that. And it's an important thing to focus on because the, the younger generation, I know there's some data out there showing that the attrition rate in chiropractic is going up, which is astonishing to me.

You're going to pay all that money, go to school for all that time, come out into practice, and you don't make 200 grand in your first three years. And then you quit. Like, no, it takes time. And there's, like you said, there's, there's, there's good stuff on the other side of hard work and looking at it as a journey, not a destination.

So,

Dr. Kevin Christie: yeah, it's so true. You're not going to make the 200 usually at age 30, um, but maybe at age 40, 50, 60, you know, you could have 20, [00:24:00] 25 years of making that money. It'll put a big dent in your retirement, but it's not going to happen overnight.

Shawn Thistle: Yeah, and there are very few professions where you, you know, if you're a corporate lawyer, you don't start out making 300 grand a year either.

So, that's funny. Sometimes I don't know what people expect. And so maybe it's a, it's a matter of being a bit more, uh, forthright with them when they apply to chiropractic school.

Dr. Kevin Christie: Yeah,

Shawn Thistle: because when I, when I applied, I don't remember ever thinking I was entitled to make X number of dollars when I graduated.

I knew I'd have to go out and build a practice. That was just part of it. And I don't know if that's changed or the expectations have changed. I'm not sure.

Dr. Kevin Christie: Yeah, it's tricky. Um, but I got one more question for you and I'm going to put you on the spot here. Um, yes, sir. Evidence based versus evidence informed.

What are your thoughts?

Shawn Thistle: So I've used both over, over time. I think when I started doing this, I was a staunch evidence based guy. And then I thought that seemed to put people off sometimes, like it made people sensitive. I'm [00:25:00] still not sure why, to be honest. So I shifted into evidence informed for a while.

And then I had a couple of our highest level scientists in the chiropractic profession ask me why I used it. And one of them said to me, well, you're either evidence based or you're not. And I'm not sure what evidence informed means. And it seems like evidence informed is turned into this partial excuse to ignore the evidence.

So, and I think that, you know, the, the language that medicine around the world uses and the World Health Organization uses, for example, is evidence based. So why don't we just use that? And it still means combining what the evidence says, what your patient preferences are, what your experiences as a clinician is.

But that model itself makes a huge assumption. And that assumption is that the clinician knows what the best evidence says. And that's where the, you know, the three legged stool just literally falls over most of the time. So that's what I try to help people with. And I think, you know, we have enough clinical guidelines now for back [00:26:00] pain, neck pain, and the things that we deal with on a frequent basis that I don't think there's any excuse for the average clinician not to have some idea, uh, what the evidence says.

And then the nuances of how the new bigger studies are, are tweaking our messaging and, and helping us, uh, inform patients and medical doctors better about what we do. For example. Is something that has to be done, uh, on an ongoing basis. So I don't really, I'm not offended by either term, to be honest, I kind of get it.

As long as the evidence informed term is not used as an excuse to say, yeah, yeah, I know the evidence says this. I'm just going to do this anyway. Does that

Dr. Kevin Christie: make sense? It makes perfect sense. And you sold me on it because I was drifting away from evidence based and evidence informed and I, that's why I brought it up to you before recorded.

I was like, you know, where does, where does Sean stand on this? Cause I'm getting confused by it now.

Shawn Thistle: It's. Well, you know, I think it also boils down to this 20 years ago to be purely evidence based, there wasn't much you could do in practice as a [00:27:00] chiropractor, because we didn't have a solid evidence based behind really anything we do.

But I think we have some answers now. And so I think it's okay to say your evidence based recognizing that health care comes with a lot of inherent gray areas. And that's okay. But to just turn away from the evidence and say it was too complicated. There's too much of it. I don't know what it says anyway, that's unacceptable.

So I think whatever term you use, you have to make some commitment to understanding what the evidence says. So,

Dr. Kevin Christie: yeah, well, there it is. There it is. We're going to go evidence based moving forward on the MCM podcast.

Shawn Thistle: We'll make T-shirts and stuff. It'll be good . Don't be, don't be scared of it. I guess that's the evidence informed is kind of, I don't know, to me it kind of implies like you're kind of nervous about it.

We have nothing to be nervous about anymore.

Dr. Kevin Christie: No, I agree. That's what's exciting about it and I think we have a great future ahead of us as chiropractors, as long as we stay on that path of mastery and keep on getting better, uh, clinically communication, all this stuff. Right.

Shawn Thistle: [00:28:00] Absolutely.

Dr. Kevin Christie: And you're playing a big role in that.

And before I let you go, how can our audience find out more about what you have going on?

Shawn Thistle: All right. So they can head over to seanthistle. com. That's where all of my courses and research reviews are. Um, if you'd like to on the newest, the new platform, when I, when I created it last summer, uh, we made all of the.

weekly research reviews available individually. So if people want to test out one or two and see what it's like, you don't have to subscribe to the whole bunch. Um, your listeners here can use a coupon code MCM 30 to save 30 percent on anything I do. And, um, if anyone has any questions about it, they can reach me at Sean at seanthistle.

com. And, uh, yeah, I'm always happy to help with, with knowledge integration or seminar speaking or helping people get their Con Ed hours. And. Looking forward to connecting with some more colleagues down in the U. S.

Dr. Kevin Christie: Yeah, definitely. And, uh, I'll put that in the show notes. That is S H a W in. [00:29:00] And so, uh, check that out.

Uh, one of the things I believe wholeheartedly in is delegating and I've delegated that I've been a subscriber of, of yours for a few years now. And it's my way of delegating to get the information sent to me. And so I can keep up with it consistently. I haven't delegated the reading of it. I'm still doing that.

AI is not doing that yet. for me, but I'm reading it, but at least it, it gives, it gets in my inbox. And I know it's like, okay, here's updates. And then it has helped to read through the slide deck material you create for our MCM members. And it's a good way of learning. And it's kind of like Blinkist, your, those little slide decks, like, Oh, I got to read up more on that.

So I can go into log into your portal and read more into it. Uh, that really has helped me clinically. And I appreciate that.

Shawn Thistle: Well, thanks. And, you know, I've got, I think we've, uh, we've done about 1200 reviews, uh, since I started, uh, doing this, we post about, uh, 50 of them a [00:30:00] year. And it's a variety of different topics.

Uh, if you subscribe to the whole bunch, as you know, you can search by topic and they're organized by topic. Um, so you can answer more specific questions and. As always, if anyone has something they'd like me to review that I haven't reviewed before, just let me know. Sounds good, Doc. I really appreciate your time.

All right. Thanks a lot, Kev. Great to catch up with you. Keep doing