Choosing the right surgeon featuring a Surgical Risk & Outcomes Advocate with OR Experience
Summary:
In this enlightening conversation, Michael Jonson, a board-certified patient advocate, shares his unique journey into advocacy, driven by personal experiences with medical mishaps. He discusses the importance of choosing the right surgeon, the complexities of navigating the healthcare system, and the critical role of patient advocacy in ensuring better health outcomes. Michael emphasizes the need for thorough research and communication in the medical field, highlighting the often-overlooked aspects of patient care and the necessity of exhausting conservative treatment options before resorting to surgery.
You can reach Michael at choosebetter.care
Takeaways:
-Michael Jonson's journey into patient advocacy began with personal medical experiences.
-He emphasizes the importance of choosing the right surgeon based on experience and outcomes.
-Many patients wish they had consulted an advocate before undergoing surgery.
-The healthcare system is complex and often difficult to navigate without guidance.
-Physical therapy is crucial before and after surgery for successful recovery.
-Michael advocates for patients with complex medical histories and multiple comorbidities.
-Surgeons who perform more procedures tend to have better outcomes.
-Patients often come to advocates after experiencing complications from surgery.
-The American healthcare system is criticized for its inefficiencies and lack of patient-centered care.
-Advocacy can significantly improve patient outcomes and experiences in the healthcare system.
titles
-Navigating the Healthcare Maze: Insights from a Patient Advocate
-Choosing the Right Surgeon: A Guide to Patient Advocacy
Host
Michael Jonson, thank you so much for being on the podcast.
Michael
Jon, pleasure to be here. Thanks for having me.
Host
You have an interesting story of how you even got into this and what you do is a little bit different. So I'm going to, I'm just going to give you the floor and let you introduce who you are what you do to the people listening because you describe it and explain it much better than I do.
Michael
Michael Jonson, a board certified patient advocate. And I definitely arrived at advocacy in a unique path from other advocates. Well, first of all, there were a few triggering events that led me to advocacy. And the first was I had eye surgery. And post-op, I woke up.
blind in both eyes, bound with my elbow, sticks across my elbows so I could not bend my arms, ostensibly so I wouldn't rip off the bandages. It's a shocking way to wake up post-operatively from eye surgery, to be blind and bound. And it was particularly troubling for me because all I wanted to do was to regress and suck my thumb because I was five years old.
the next event was, as I was training to be an implant specialist in the operating room, I was scheduled to shadow other implant specialists for a couple of months. And, day one, I did a series of ACDFs that's anterior cervical discectomy infusions.
spinal neck surgery, watched one surgeon do it all day long with one device. And the next day I was to go to another hospital, work with another doctor and another implant specialist on a completely different device. And I was told that the implant I used yesterday was a backup and there was a 1 % chance that I might be using it. At the scrub sink, it was pretty clear to me that the doctor
didn't know what was going on. He didn't know the terminology for the two different implants. And he said, no, I don't want that one. I want the other one. And the other expert who I had just met said, that's you and left. So, so thank God I'd read the surgical technique as my 1 % backup plan seven times the night before, but I read it five more times before surgery.
Michael
Then I Googled the doctor and I saw that he's a hip and knee replacement guy. That's what he does. That's what he advertises. That's how he builds himself. So as soon as the patient was intubated, I walked. What's that?
Host
And he's doing a neck surgery, a spine. He's doing a spinal and neck. He's doing a spine and neck surgery just to be clear, right? Okay.
Michael
Yeah, yes, and I'm reading his bio and he does hip and knee replacements. So needless to say, this was concerning. And the fact that he didn't know the names of the instruments we were discussing at the scrub sink was the first red flag. I walked in to speak with the anesthesiologist and I said, we're doing spinal fusion here, right? Cervical spine surgery. He goes, yeah. I go,
but this doctor is a hip and knee doc. And he looks at me and he goes, he likes to dabble in spine.
And I said, those are words that should never be spoken again, certainly by a surgeon. And I was quite concerned. Now, as the procedure began, I had to walk him through every step of the procedure. He had perhaps used it before maybe two or three times a year or so ago, which is not enough to be proficient at it, to say the least. And...
Host
Yeah.
Michael
I looked at him grabbing a very long screw and you don't yell in the operating room and you don't call out the surgeon when he's doing something wrong. So I said, scrub tech, take that 7.5 millimeter screw from the surgeon, give him a 3.5 millimeter. And the reason I said that is because the 7.5 would have gone
into the spinal cord itself and most likely made the patient a quadriplegic.
I then walked him through every step of the procedure, including getting him to straighten out the fusion plate. And at the end of it, he thanked me for my expertise of which I had none. And that was the first time I said, wow, how did this patient go about choosing this surgeon? You've got neck pain, maybe radiculopathy, some numbness and some fingers.
Host
Hahaha
Michael
and you walk into a busy orthopedist's office and he was notoriously backed up. So there's a pile of people with walkers, wheelchairs, and canes limping along with their bad hips and knees. And he managed to talk this patient into fusing her spine.
So it really was a wake up call for me. And the first time I said, people really need to figure out how to choose their surgeons, but how do they go about doing it?
Host
Before you get into the next part where you talk about how you help people, can we just go back to the eye surgery? I feel like you left me on a cliffhanger there. What happened?
Michael
Yeah.
Michael
They just didn't want a five-year-old to rip off his images. Why the other eye was covered, I have no idea to this day. And the surgeon was a world-renowned eye surgeon. It was a rather simple procedure. But just the trauma of waking up bound and blind without being told that at five, hey, he could be 60. At five, it's terrifying.
Host
Okay.
Host
as a five year old. Right.
Michael
And, you know, my advocate in that case was my mother, who was a long, at that point, long retired nurse. And she busted her way through, heard me crying, busted her way through into the post anesthesia area and asked permission to unbind my arm so I could simply suck my thumb. So yeah, I just, it was amazing to me that
Host
Yeah. Okay.
Michael
You know, my mother, the nurse wasn't told, it was never explained to me. There was no knowledge. She didn't know. And you know, it might've just been an afterthought. he might wake up and just tear these off, but be there with the patient and let them know, hey, you're okay. You're not blind. Your eyes are just covered. We'll take these off of you. Just don't tear off your pantages. Okay. I mean, I was a compliant patient. I always have been. There are those who are not. get it. But a little communication.
Host
Okay, so back to you know the surgery, the ACDF and kind of the post-op where you realize something here is not right. What happened to you next? Kind of how did you take me the next step on the journey for you?
Michael
Well, immediately afterwards, the adrenaline flow was just unbelievable. Decompressing from that was amazing. And my superiors were just awestruck that I was running that case on day two. I, however, was just profoundly disappointed that this is the way it goes down. You know, it was a real eye opener, if you will. I had a more logical
progressive learning experience where I learned a whole array of spinal fusion devices, some really, really interesting stuff. Worked actually with some amazing spine surgeons subsequently. Some of my favorite guys were doing idiopathic scoliosis, so children with curved spines. And one of the great cases from there is, so,
For kids with scoliosis, if the curvature is so bad, and just so you know, if you look at the front, the AP x-ray of one of these people, know, normal spine is straight up and down, and you'll look at it, it'll be an S curve. And they don't want to correct that until they're skeletally mature. But this one kid, about 16, 15, maybe a few more inches to go,
was actually curving so bad he was crushing his internal organs. And we went in there and straightened him out and he was nine inches taller after surgery and was fine. It changed his life. And yeah, this isn't the Shriners. They do amazing work. It's for free. They fly in the kids from around the world and the surgeons who work there could make more money elsewhere. They love what they do.
Host
Ouch.
Host
Wow.
Michael
And that's my kind of surgeon, somebody who's gone, don't care about, you I care about my patients, I care about healing, you know, they're not focused primarily on their Porsche payment, whatever. So I really got attracted to those kinds of surgeons and learned to recognize them. And that was definitely a piece of the puzzle that helps me in advocacy today.
Host
Amazing. So.
What, when did you start deciding that you were going to really help people?
you know, navigate choosing surgeons. how, like what's the time gap between that surgery and you actually taking the taking on private clients to help them this way.
Michael
about 12 years. And of course, before that, just as most advocates do, I'm helping friends and family and friends and family. And there were a couple of moments there that were key. I didn't, I had no idea that board certified patient advocates existed. I'd never met one. But I had an idea about writing a book about how to find Dr. Wright.
I learned that that phrase is trademarked by Baylor and it's their search system for how to find a Baylor surgeon. And so I dropped that like a hot potato. And later I realized that no one's really gonna buy a book about how to advocate for yourself or your loved one until it's too late. And they simply need to pick up the phone and call an advocate. So there was a friend, a colleague of my wife, a professor.
happened to be in San Francisco, happened to be within the Kaiser system. And he was an avid hiker and quite young for someone who was being told that they needed total knee replacement. I believe he was 42, 43 at the time. And he had plans to from the bottom to the top of Machu Picchu. And he's certainly not gonna do that after a total knee, not within...
Host
Mm-hmm.
Michael
a year or more. And the real problem, I told him, with a total knee at his age, is that they typically are revised. They're done every 12, 15 years. They're getting better. There are now some out there where patients find 20 years in. But at the time, you're lucky to go 12 years between revisions. And at 42, you're not going to have enough bone left after four revisions when you're 80.
and there's not enough for the doctor to work with to get a good balanced knee. Okay. So I said, there's partial knee replacement, which typically works on one side instead of placing the whole joint. It just replaces the superior or inferior portion of it. And that way, when you do need a full replacement, you've got all that extra bone to work with. Okay. So,
I said, you know, I don't know Kaiser that well, but I suspect that they won't care if you pay your own money and travel a hundred miles to the surgeon I know who doesn't care about the lawsuits that might happen. And I need to back up a little bit. The partial knee was out about five companies made one. One company in particular made a bad one that
didn't have the perfect ball and socket and wore out in places causing metallurgy, which is just a terrible problem I won't get into. And so they rightfully pulled it off the market. Now, the legal minds and all the other device companies said, so-and-so pulled this off the market. We better pull ours for no good reason. And they did. And there was one company that
Host
Mm-hmm.
Michael
didn't market it, but still had it available if you knew about it. And I said, this doc, the other thing is the hospital lawyers were basically going, no doc, you can't put him apart because there were bad ones out there. And so they basically banned the procedure. And I said, I know this doc, he's not going to care about this. He doesn't care about the attorneys. He doesn't care about the lawsuits. What he cares about.
is the best patient outcome for his patients. And I suspect that your insurer will not care if you get yourself there. You can pick your surgeon and I bet you he does it. And sure enough he did. And nine months later, that professor hiked Machu Picchu.
So when I heard that he, got the procedure done, it was amazing to me. It was amazing that with a few minutes, I actually could help this guy and get a better procedure than his surgeons were telling him to have. But what was really astounding is, you know, he hiked Machu Picchu nine months later. So.
Host
Yeah, it's incredible. How did you even know about the doctor and the partial knee and all of that?
Michael
I knew about the partial knee because I had to be on top of all the implants. You know, I had to know who offered what. What was unique about me is that I would tell doctors about some other, you know, some other knee that I had no part of. I said, this might be better for that patient. And then they go, oh, this guy really cares about patients. He's not just trying to sell knees. And I was effectively the medical salesman in the room.
And so, you some doctors really would lean on the expertise and others just go, you're a peddler. But when I showed that I really cared about the patient more than making a dime, that earned a lot of trust with those kinds of surgeons.
Host
Mm-hmm.
Host
Yeah. How did you even get into medical sales?
Michael
I had avoided medicine like the plague. My father was a surgeon, my mother was a nurse, my grandfather was, you know, head of a huge department at Jons Hopkins. And when I was young and influential, about 12 years old is when the malpractice insurance crisis happened. And my father...
who loved doing surgery. He was one of the first hand surgeons. was an orthopedic surgeon who gravitated towards hands and became one of the first specialists in hand surgery. And he loved what he did. But I remember he was just wallowing in depression as he found out his malpractice insurance would be about 375 % more that year. And he was planning on buying a van.
and being a fix-it man on the spot.
from surgeon to handyman. And that had some effect on me, pushing me away from medicine. But really it came down to marrying a lovely woman, having two beautiful children and really wanting to provide for them. And it was during the financial crisis when I saw a guy in the neighborhood while everything's foreclosing.
This guy's picking up his kids from school in scrubs. And I saw him with a realtor for sale sign. I something like, my God, he got foreclosed on? No. He was moving up into a bigger house, taking advantage of the financial.
Michael
issues that were going on. It was really bad. And I said, wow, he's taking advantage of this. What does he do? So he's a medical device salesman. said, well, I need to go into a growth industry so I can take care of my family. And what I found is majority of the salesmen are salesmen. They're at the high level of sales, but they're ready to just, they just want to move numbers. And I saw some really, really crazy things in the OR.
really disheartened me and that those also drove me towards advocacy. So I just I couldn't take money over patient care. I'll take patient care over anything and as an advocate that's my that's my mom.
Host
makes sense.
Host
Yeah. How many years did you do med sales for?
Michael
about 15 years, 15 years. And so I started out during.
Host
Wow. You have that thorough knowledge of the whole industry.
Michael
Well, and a lot of intimate interactions with surgeons and seeing the very best and seeing some of the very worst. And the difference in patient outcomes between that those patients have between the best, the mediocre and the worst is absolutely profound. It's extremely important. And people have no idea how to find a surgeon. Like Google AI will tell you
everything about a malady, everything about the treatment options. But, you know, they're not going to tell you, you cannot find out who the good surgeon is. You can't Google that. Anything you see about a surgeon's greatness is marketing hoo-ha. And if you see anything bad about a surgeon online that's truly bad,
Host
think everybody, everybody has experience like this, either with a friend or a family. remember going with a family member to a checkup with one of their doctors and they asked who did this surgery for you. And it was years prior. And then my family member said the name and it was if you weren't paying attention, you would have missed it. But there was a wince on his face like
Like that's surge. And I'm just like, that's what like nobody told us were 10 years later. And my family member won't get another surgery because of how horrible the outcome was. And he still to this day, if you, if like, literally, if you rolled your eyes, you would have missed the wins. And I was like, that's all I needed to see that, that the surgeon kind of screwed this person. So now we get into one of your big specialties here, which is how do you find what surgeon to use?
Michael
Exactly.
Host
bedside manner is not what I've learned, a good measuring stick for surgeons at all. So what do you kind of do to help people understand how to actually figure this out? Because it's kind of a labyrinth in the medical space.
Michael
It is. There's a lot of things you have to utilize. But really, like I've heard people say, I look at how many lawsuits they've had. It's like, well, the busier the surgeon, the more lawsuits they're going to have, good or bad. So that's no good. And it really comes down to, for the most part, the simplest way to answer that.
is the surgeon who does it more often than their peers and has better surgical outcomes than their peers. So how do you go about determining that? Well, I'm going to go talk to, you know, you talk to a charge nurse in a busy OR. You can talk to physical therapists if they see
number of patients and if they specialize if they every kind of physical therapy probably not but if they do say you know hips and knees and things like that and they do it from a multiple providers multiple facilities which is getting increasingly hard to find these days but that's a phenomenal resource for people
Another thing I'll do is have a conversation ostensibly about something else with the surgeon's surgery scheduler. And I'll ask them about, say, shoulders, if I'm researching a knee or a hip, because typically those doctors do the same, those three procedures, hips, knees, and shoulders. I'll ask her a lot of questions about shoulders, and then, thank you so much, I'm gonna let you go.
Can you tell me how many knees Dr. Smith does every year? It is about 20 to 50. Like 20 to 50. Now the conversation is over with that surgery schedule, but I'm saying to myself 20 to 50 is not proficient enough. It's not enough to be really good at that craft. You need a couple of hundred. And if they do more, fantastic.
20 knees a year is producing probably 19 miserable patients a year from that procedure. So it really is quantity. Now, quantity alone isn't enough. And there's some interesting data that we started collecting when Obamacare went into effect. And they started counting blood loss statistics.
So internal blood loss post-op is a really good judge of surgeon quality and ability. And Medicare now dings hospitals for certain levels of internal bleeding on hips, knees, and I believe it might be shoulders. And you can't look at this doctor has these internal bleeding scores.
you can look at the facility. So if you find a facility that has a bunch of doctors, a bunch of surgeons, it's more difficult to determine that, you which one is the one that's having the great results and which one's having the bad. If you've got a two or three hip and knee surgeon facility,
Michael
It's a lot easier. go, okay, well, they're really high. There's three docs, you know, and then you start finding out who does the most. That's some of the techniques I'll use. very rarely, almost never will refer to any surgeon I've worked with. I want to avoid that conflict. I have, but only when I've determined that that's the best surgeon in that area.
for that client. So those are some of the techniques I use.
Host
So what are you, what's the process like? Let's say I'm calling you because I'm considering getting a shoulder surgery and I don't even know where to start. Do you start asking questions about why I'm getting the surgery? Do you start asking about insurance right off the bat? What does it feel like and look like to work with you?
Michael
Yeah, good question. So I do want to know where you are in your disease state, if you will, with that shoulder. I want to know what conservative treatments you've done. And I want to know what kind of insurance you have because immediately I'm going to go, what doctor told you they want to do a reverse shoulder on you? there are in every
Every community, there's typically multiple systems. Any medium to large town has more than one hospital typically. And it is very clear to me that one hospital's good at one thing, this hospital might be better at another, and this one has a better orthopedic team. But even then, it's how busy are those surgeons?
you know, what are their patient outcomes? And so I'm immediately going to see, well, you know, that's a shoulder surgeon who's in an inferior orthopedic hospital potentially. And maybe since you've got a PPO, we can go get a second or third opinion over here where they've, you know, here's where they pioneered some shoulder technique.
you know, here's a gal who's done it for 20 years. And so I definitely will, when they're willing and able, I will move people into the better system where they can get better care.
Host
Amazing. And I'm sure you see kind of this broad spectrum of different types of surgeries that people are coming to you with questions about, is that right?
Michael
Yeah, absolutely. So I think all advocates, you know, come from some area of specialty, expertise. I thought that I would be helping people as I did with the professor with his knee, his hip. But when someone needs an advocate and they identify one that can help them, they just go. So I find myself managing very complex cases. I've got a client right now that had
shoulder surgery, spine surgery, in the middle of spine surgery. No, that's not accurate. Then they had discovered a heart condition immediately after spine surgery, going to do a aortic valve replacement and then turn it into a full three-way bypass. So this is now a patient and then they had a stroke in the middle of surgery. So this is shoulder surgery, spine surgery, heart surgery, and now a stroke fixer.
So very, very complex cases seem to gravitate towards me. And the system, and especially certain hospital systems where they may also be the insurer, tend to be very difficult to navigate when you've got comorbidities, when you've got malady stacked on top of malady. Because the specialists...
are so focused on one area of the patient, you might have all kinds of specialists working on them, but there's nobody overseeing the entire patient, their entire, their health and all of their care. And it's shocking to me, but I find myself often coming in and quarterbacking that and forcing communication between various specialists. And
You know, it's just one of the things that surprised me as something in this industry surprises me on basically a weekly basis. I mean, it doesn't surprise me. I'm usually disappointed these days. Like, that's happening now? Because, you know, Walter Cronkite said decades ago when he was the most trusted man in America, he said, the American healthcare system is neither healthy
Michael
caring nor a system. And he's, it's more true today than it was when he said it. And, you know, cause systems are navigable by people who've never been there, you know, there's a map. so this situation we're in requires people who are exposed to the nuances of it all the time and have seen what goes wrong over and over and how to fix it.
I don't know if I answered your question, but that's my.
Host
Yeah. Yeah, you did. I have to follow up on that. So do you find that people are still coming to you? More often than not regarding surgery, but then you kind of have to do this wraparound holistic advocate care for them, or do our people coming to you as an advocate sometimes not even asking about surgery first because of the reputation you've earned over the years?
Michael
Well, unfortunately, what I hear all the time is, I wish I talked to you before I had surgery. I deal with a lot of patients who've had, been treated badly, who've had the wrong operation, who've had it done by somebody who doesn't have the experience and shouldn't be doing it. And fixing it after the fact is...
is often just painful and sometimes tragic. So as much as I would like to have people talk to me beforehand, it's usually after it goes wrong, they contact me. And I think that's probably true with most advocates.
Host
Yeah, unfortunately, that's the heart, one of the hardest parts of the industry. Talk to me about surgery specifically. What are the, what are the most common ones that you see that have complications?
Michael
Well, spine is the first thing that popped in my head. One of the things that really annoyed me about working in spine is, in my opinion, I saw a lot of unnecessary surgery. I don't think anybody should have spine surgery without having exhausted every conservative option.
And I'll hear people saying, I don't want to do the physical therapy beforehand. I just want to have the operation. If you're not willing to do the physical therapy before surgery to see if you don't need surgery, you're not going to do the physical therapy afterwards. And you can have the best surgeon in the world with most of these procedures. If you don't do the physical therapy, you've failed yourself.
And I hear people blame their surgeon all the time. I stopped doing the physical therapy. It was a bust. And, you know, it's tragic. It's tragic. They're not fully informed. Doctors are required ethically to get informed consent. But the system, if it's a system, really doesn't allow them to do that in the 15 minutes a doctor's allotted to speak with their patient.
Host (35:54.1)
Yeah.
Host
Yeah.
Host
Yeah. Do you see as many patients or clients in your world from elective surgeries?
Michael
Absolutely. think a lot of spine surgery is actually elective. Or at least they certainly haven't exhausted all the conservative treatments. Yeah, you see crazy things from plastic surgery, aesthetics, and that gives me great pause. I don't...
really understand elective surgery unless you're doing reconstructive surgery, you know, after disease or trauma. I understand what people want to look better and society drives that, but...
I don't even think, you you look at Botox injections and people aren't even getting that right. They're walking around with, you know, duckbills so many times, you know? And you think that's aesthetically pleasing. I just, I wouldn't risk it. I wouldn't risk it. So I see it really from all over the place. And...
Host
Yeah, sure.
Michael
I mean, one of the other patients that drove me into advocacy before advocacy was a friend of mine that is not a vain man. And I saw him with glasses for the first time, clearly readers. And then I see him a week later and he's got different readers. And then the next time, another week later, he's got other ones. said,
I said to him, you're not a vain man, but I see different glasses on you every week. And he goes, well, I keep needing more powerful ones. I said, you need to go to an ophthalmologist right now. And he called me a week and a half later saying I went to the optometrist and the optometrist sent me to the eye doctor. I go, you mean the ophthalmologist? He said, And he goes, I went.
And now the doctor called me and wants me to come in and talk to me. said, I'll go with you. And we went in and saw his ophthalmologist and she was scared. I saw fear in her eyes as she described what she saw. And he had a macro pituitary tumor, which was so big it was impinging.
on his optical nerves and causing him blindness, tunnel vision. And it was a pretty interesting process. He had pretty poor insurance with probably the fourth best hospital chain in the county out of four. And they were going to force him to go to their neurologist for this. And I said, I'll go with you.
And I had identified a guy who invented the procedure for dealing with macro pituitary tumors. And I'll tell you what he did in a second, but we walk into this neurologist's office and he's got sports memorabilia behind cases. And I hadn't seen an office that fancy, with that display of wealth since I'd been in a plastic surgeon's office.
Michael
And this guy came in, he very young, and he talked about how they buzz off the top of the head and go into the pituitary gun. And my friend didn't hear anything after. They'll open up your head and he said, but there's a guy in San Francisco who invented the technique and they fly all over the world. And this is the guy I had identified. And they go up through the nose and extract it very carefully.
And he goes, I'm going to refer you to him out of network. And I didn't say anything in that case. I just wanted to make sure he wasn't going to cowboy it and try to do surgery that he had no experience in on my friend. And he actually did say, I'd love to do it. But there's a guy in San Francisco who's got experience at this. And so my friend went in there and he, within an hour, his tunnel vision went away.
His vision cleared up and he's fine.
Host
Amazing.
Michael
So I still advocate for that family to this day.
Host
Wow. Are there kind of last question? Are there any surgeries that you other than spine maybe where you say like, maybe hold off on that surgery, you know, like that, like where it could be anything, you know, from knees to vasectomies to cosmetics to anything where you're like the outcomes on that just stink in general.
Michael
Well, let's take aesthetics out of it for this, for the purposes of this. And I think if you, got to make sure you've done all the conservative treatment. A lot of people just don't really want to do it. they, know, Americans, we want the pill that fixes us. And a lot of us think that surgery is that pill. And let me tell you, if you're not willing to do the hard work to rule out all conservative treatments,
before surgery, you're not going to do the physical therapy afterwards to fully recover from it. So I make sure that people are fully aware of that. But as far as specific surgeries, no, I think you've got to really rule out that you can't PT your way to health and that surgery really is needed.
Host
Okay, well, if someone wants to work with you, Michael, what's the best way for them to find you?
Michael
My website is choosebetter.care. That's choosebetter.care and offer free consultations and I network with every board certified patient advocate I can find with every specialty and every location across the country so that I can help you when you travel or I can help your loved one who's not where I am. yeah, reach out. Happy to talk with you.
Host
Thanks so much, Michael, it was really enlightening. I appreciate the time.
Michael
Thank you so much, Jon. Pleasure. Take care.
