Dr. Matt Sherrer (Host 1): Welcome to the Fresh Flow Podcast. This is the final episode of season two. Mitchell, we did it, man. We're almost there. We got to finish the race, okay?

Dr. Mitchell Tsai (Host 2): Who would've thought?

Host 1: Yeah, no kidding. So, I feel like there's been a little break since we recorded last. I haven't really heard from you much. What's new with Mitchell Tsai? What do I need to know about you between last time and this time?

Host 2: Not much has changed. I'm still causing problems wherever I am. And I'll see you in about a couple days for coffee next Monday, 9:30, Starbucks. Which one though? There's so many Starbucks in that hospital.

Host 1: We have one right here in the hospital, right downstairs from the operating room. I'll see you at that one here pretty soon. Excited that Mitch is going to be here in Birmingham with us next week. So, Mitch, you want to introduce our guest?

Host 2: Absolutely. And then, you know, as a complete side note, we should figure out a way to actually record this while we're in the same room, and see what happens. I get the pleasure of introducing Dr. Andy Lazris, board-certified in Internal Medicine. He has been practicing Internal Medicine Geriatrics for 30 years. He graduated magna cum laude and Phi Beta Kappa at Brown University. And then, he went to complete his medical school training at Albert Einstein College of Medicine-- note, on a full merit scholarship before a hedge fund manager dropped a bunch of endowment dollars. So now, everybody goes on a full merit scholarship. He trained at the University of Virginia, which I just visited Charlottesville. It's a beautiful place.

But I'm really excited about our guest today, because we talk about anesthesiologists and that's sort of been what we've been focusing on. But we have been called the internist in the operating room. And so, I'm really looking forward to Dr. Lazris' view on how we take care of patients better.

Dr. Andy Lazris: Well, thank you. Great to hear from you guys.

Host 2: Dr. Lazris, medicine represents one of the original humanities. And in fact, if you look at our hallways in my department here at the University of Vermont, the first anesthesiologist in Vermont was actually Thomas Dodds, and he was a family medicine physician. You take care of patients at a different setting, different scene, different clinical context than we do. And we know that the current healthcare system isn't delivering or doing what it needs to do. Where do we need to start, not as anesthesiologists, not as internists, but as physicians to make American medicine better?

Dr. Andy Lazris: Yes, I've been doing this for a long time. And, like you, I cause problems wherever I go. And that's part of what we need to do actually, is to just shake up the system a little bit. There's a problem when you say we as physicians, because there's definitely a gap between we people in primary care who are an extinct species, where there are very few of us left and none being produced, and the specialists who a lot of the specialists actually feast on the system we have, which is to do everything to everyone, to create a lot of new diseases by changing the numerical norms of what constitutes a disease, i.e., we make more diabetics by lowering what the normal sugar is. And people aren't pushing back against that because it's actually something that helps make money.

So, as doctors, as a group, the first thing we need to do is get a system with some degree of pay equity that treats us as physicians and not people who get paid to do a lot of things to people. And they've talked about this many times, it all starts in CMS in the home of Medicare, which is literally down the road from where I am and where I know lots of people. But it starts with them rewarding doctors for seeing patients and talking to patients about problems and convincing patients that they are in charge, and it's our job to give them right information.

 To give an example, what we don't want to do is encourage a cardiologist to order stress tests, echocardiograms, then caths that they get paid for. So, what we call self-referral. We want to actually make sure that that doesn't happen, that they get paid equally well if they don't send people for all those tests, that they talk to people. So if we are, like you say, the humanities, if we are what Dr. Osler thought we should be back in Hopkins, before things went awry, we would be basically using the Osler first rule is if you want to know what's wrong with the patient, ask the patient. The patient's in charge, it's our job to make sure we understand how to diagnose and treat a patient, but also that we understand our patients and that's what we get rewarded for.

Host 1: Yeah. So in your book, which we'll talk more about, Curing Medicare, you talked a fair amount about the reliance on numerical quality indicators. We are in a very pressured environment of churning out cases as fast as possible. I'm certain that in the primary care world, that is something that you deal with as well. If you want to get an anesthesiologist's blood pressure up, mention first case on-time starts. So, your thoughts on primary care operational metrics and perhaps what we ought to be focusing on instead?

Dr. Andy Lazris: You know, one thing, I happened to just had a surgery recently. I generally don't have any experience with the medical system personally, but I decided to get a new knee. And so, I got to meet some of this anesthesiologists who actually were the best people I met during my whole experience there.

But the idea that when they came in to talk to me, they spent some time, they had looked over my record, my blood pressure was pretty high, which the nurses were freaking me out about. But he said, "Of course, it's high. You know, you're a super healthy person. And you know, I'm not surprised it's up a little bit." The idea that the anesthesiologist can have some time to look over what is going on with the patient. I've had bad experiences too. I had an anesthesiologist recently deny a patient's surgery, a very minor surgery because he hadn't been taking Eliquis for atrial fibrillation. Well, he hadn't been taking Eliquis because he was bleeding and having other problems, but they said, "We find this to be too risky." And by the way, he now has a huge hematoma in his groin after the surgery. So, we as primary care doctors would love to be involved. All we do is write a pre-op note. It is very vague. And then, you guys take over the primary care. And I would love a situation where there could be a conversation, even if briefly, to kind of talk about the patient a little bit. Because we're the ones who know the patient really well, and then you guys have to know the patient really well.

So, to me, that's the best thing. The communication with us and everyone in the hospital is not what it should be. And I think that would make a huge difference in terms of patient care and you understanding the patient that you're about to take care of.

Host 2: I think there are systems out there. I think of Hospital for Special Services in New York where the anesthesiologists work with the internists, the Marshfield Clinic, right? It's a collaboration. I've always joked that the history and physical and the anesthesia pre-op evaluation, the surgical history and physical are pretty much the same documents, just different parts are important, right? So, how can we be more efficient, more effective?

Going back to this idea that we create epidemics by changing the numbers and changing the rules, you know, in our careers, Matt and I, we've seen hypoglycemia, simply because we've gone with intensive insulin regimens trying to regulate blood sugar levels, right? We've also seen more strokes because we're trying to figure out the magic bullet that's going to prevent major cardiac disease afterwards. So, I think every specialty is involved in trying to figure out how to provide better care. And in some instances, we probably hurt patients more than we do help them.

And then, to continue this discussion, you've talked about pay equity, But what about the delivery of equitable care? And I think that the pandemic sort of hurt us and helped us. I think we learned a lot of things. But with the pandemic over, I think we've thrown a lot of the things that we could have done better afterwards. How do we change that mindset so that we take things and then move them forward?

Dr. Andy Lazris: I mean, you're right, the pandemic should have been an eyeopener. And a lot of us who are in the realm of trying to reform medicine, all felt that it is going to have a silver lining, that in the end we're going to see how dysfunctional the healthcare system is. The fact that, in the rest of the world, the people who died of COVID were all old. In our country, it was old and poor. And my friends who I wrote our recent book Return to Healing with, works in Jamaica Hospital in New York, which was the center of COVID deaths. It became a COVID hospital. And his patients weren't necessarily really old, they just were uninsured, working two jobs, having to continue to work during the pandemic because there was no effort made to keep people at home other than to tell them to stay at home. But, you know, when you don't have enough money and you can be fired, you go to work. And so, they had diabetes out of control, blood pressure out of control. We're eating poorly. And those are the people who did terribly. And most countries in the world don't have this. They have healthcare for everyone. We don't. We have healthcare for the few. And even the people who have healthcare in our country have limited access, especially to primary care.

So, what the pandemic should have showed us is, "Wow, we have a blip of people who are dying from this disease that no other country had. What's wrong with us?" But you don't hear anyone talking about that. Health equity ultimately can only occur under two circumstances. One is that we reduce the cost of overall care. We're paying now $5 trillion for our healthcare system, and we have among the worst results in the world. And we have to look at this with clear eyes and say a lot of this stuff we're doing-- and people estimated it's about $2-3 trillion-- a lot of stuff we're doing is not helping anyone, and all the studies show it. So, we have to stop paying for that stuff. And when we stop paying for that, guess what? We can give care to everyone easily.

So, those are the two things that have to happen. Again, there's a huge pushback from what in the book we call the Medical Industrial Complex, which includes pharmaceuticals, hospitals, specialists, a whole group of people who make a ton of money. Insurance companies make a ton of money from the system as it exists now, who would push back against that change.

But even a guy like Bernie Sanders, who once Healthcare for All, has never once said, you know, we got to stop paying for all this healthcare to the extent we are. And we have to open our eyes and look at what is costing us too much, then we're not getting any bang for the buck. When he got a heart attack during the campaign, he never once mentioned the fact that stents in our country cost about 10 times more in other countries. You know, he didn't talk about it. So, the people who want to reform healthcare really have to understand the real issue is the cost of care. Then, we could give it to everyone very easily and still save money. Because guess what? If people get health insurance, it's going to save the system a ton of money. Because this bad stuff that happened during COVID happens all the time. They get heart attacks, they get cancer, they get diabetes, and they end up in the emergency room, costing the system a ton of money in addition to the human suffering that goes on. It's absolutely unnecessary. So, everyone needs a primary care doctor. Everyone needs insurance. Everyone needs full access to the system. But to do that, we have to chop, chop, chop where people are spending money unnecessarily.

Host 2: So, a shout out to Eisenhower for warning us about the health industrial medical complex almost like 50, 60 years ago. But, you know, correct me if I'm wrong here, Matt. Over my career, our patients have gotten sicker, not as healthy, they're more complex and, you know, yes, some of it could be attributed to the aging of the population. But I think there's a line like the disease progression's gone up higher much faster than what we think it should be.

Host 1: I read pre-op evaluations all the time and look at the just sheer number of diagnoses and go, "How is this person walking around-- good grief-- with all the diagnoses they carry? So, Mitch, Bernie's your neighbor, right? Doesn't he live next door to you or something like that, right? You want to talk to him about those things?

Host 2: I've actually only seen Bernie Sanders once, and it was at a Circuit City over 15 years ago because Circuit City is now bankrupt. That's how old I am.

Host 1: So, Andy, you said something in there that was interesting to me. You said you don't hear anybody talk about that, and I would offer that you're one of those guys who goes and talks about that. You have done it numerous ways, be it writing articles for newspapers, you know, for NPR, and then writing books, right? So, how did you get started on this kind of outspoken journey of yours? And then, it can be a separate question later if you just want to talk about how you got started, but I also want to know about the process of writing books and how that works and how you fell into it and what it's like for you.

Dr. Andy Lazris: I learned early on. I mean, when I was at college, I wrote a thesis, which by the way was 200 pages, because I just gave Mitchell my thesis I just wrote for Masters, which was like 130. But it was 200 pages and it looked at the history of healthcare of the poor-- I was a history major-- from 1950 until the present, which was in the 1980s. And I saw that, first of all, the AMA was a huge problem at that point, and the doctors were also obstructing the idea of getting healthcare to where it needed to be.

When I went to medical school-- I went to a medical school, you say Albert Einstein, it was in the Bronx. We are one of the few medical schools that takes care of our neighborhood. We took care of the entire Bronx. Einstein was dedicated to doing that. You look at any other New York medical school, you're not going to see that. And I worked with people in the Social Medicine Department who brought me into the South Bronx all the time. We did projects, we talked to people. And I just saw that this did not have to be this way. There was a huge impediment in the medical system, actually providing good care. We were never talking about diet, never talking about exercise, never talking about the true determinants of health, which include bad housing and all sorts of other problems that were lead paint. It was still lead paint all over the place in the Bronx.

And when I went to residency at UVA, again, I saw that people were just being hospitalized with problems that should have been solved before they got to the hospital, and that the hospital was not the answer, it was making people sicker. Something I still hold to to this day. We saw that during COVID, people who were hospitalized at the same level of illness were more likely to die if they were hospitalized. And hospitals themselves, I know you guys work in them, so beware, but hospitals themselves kill about 300,000 people a year, based on medical errors and overtreatment and infections.

So to keep people out of there and to have a primary care base would lower the list of diagnoses, which, by the way, half of those diagnoses you're seeing are kind of fudged because the numbers keep changing. We have new blood pressure guidelines that now want everyone under 120, which is for my people would be everyone would be on the floor passed out. So now, we're going to call them hypertensives if they're 125. We're calling them diabetics or pre-diabetics if they're a hundred sugar. I mean, so half the things you're seeing are fudge, but it puts people into a system that chew them up. If everyone just had a primary care person and stayed out of the hospital as much as possible, and we had resources and the outpatient world, so I saw that. So, that's what I've been fighting for.

And I met my co-author, Alan Roth, at a conference on overtreatment, and that's why we came up with this idea for a book. We both quoted Osler to each other, and we had never heard anyone quote Osler before. So, we kind of realized there was a book in the making. And I had learned enough about reading history and writing my thesis where the problem was. So when I wrote Curing Medicare, I really felt like something needed to be said about the way we're treating older people, and the fact we're just reducing them to numerical diseases and not addressing their real problems and overtreating the heck out of them and really abusing them for profit. So, that's why I wrote that book. That actually flowed from my experiences. I told a lot of patients stories, but I had read so much in terms of studies. And it's really important when you read studies to distinguish between pharmaceutical studies and what I call more objective studies. And when I saw the difference, that really prompted me to write the book and to use studies that were reasonable.

This next book, which was about a three-year process, we really wanted to show why our system went astray, how it had become so corporatized and, again, look at the way doctors think and are trained. I have one kid in medical school, one kid who graduated, and I saw kind of what they went through. The training process was very much multiple choice. One right answer, no discussion of determinants of health other than on the most superficial level, the idea of just measuring and treating things, not critical thinking. It's all protocols. These little calculators they have on their phones, just stuff that takes the thinking away and the patient became unimportant because whatever the patient tells you is erased by the protocols. So when I look at what happened with what's called the Flexner report in 1911, I studied that and I said, "Alan, this is going to be a great topic for a book. We can put all this together, throw in a little history, talk about our patients and what we've seen, and then talk about the components of the medical industrial complex and how they are empowered with the hope that people will understand that everything they think is normal in the healthcare system isn't. It's actually triggered by industry, and that industry has trickled down to doctors through protocols and through very biased studies that the doctors just cling to without really critically reading." So, that's why we did the books. I love writing. And I write fiction too that nobody reads, but it's a way to get it out of my system

Host 1: Yeah, it's a great release. Absolutely.

Host 2: So, I'm going to distill what Dr. Lazris just said. Matt, all that time you're spending on the preoperative evaluation, half of those diagnoses don't really matter, okay? That's number one.

Host 1: Yep.

Host 2: We're just kidding here. Number two, in terms of pharma, the specialty of anesthesia, I mean, I have less drugs to use today than I did 10, 15 years ago, because manufacturers, we don't have pancuronium. I could probably list a couple of the drugs that we don't even have anymore or use. Halothane is probably one of the big ones. But the thing that I want to really touch base on is this critical thinking aspect, right? That it always starts with the patient. And we had a pediatric anesthesiologist here who was actually the son of the original chair, Chris Abajian. But Chris always taught us take care of the patient, right? It's not the numbers-- the numbers are important. The pulse oximeter, the blood pressure, all that is important, but it's not distilled to one number that tells you how well you're doing, There's a context to everything that we do as anesthesiologists in the OR.

Dr. Andy Lazris: I was telling the story of I just had my knee surgery, and the nurses were freaking out by some of my abnormal numbers. And the anesthesiologist said, "Don't worry about it. You know, you're super healthy. Obviously, you're stressed. We're not going to worry about it." That was so refreshing to see that. I don't see that so much in the primary care world I'm in, and I don't see that among hospitalists. And I don't know if in your hospitals you have hospitalists. But we have pretty much been knocked out of the hospital, as primary care and hospitals take over and freak out about every abnormal number and reinvent the wheel without ever talking to us, calling specialists, more medicines. Someone can go in with a hurt toe and they end up seeing five specialists and come out with six medicines, and be sick as a dog. And not once did they talk to us. Even though we've been trying, I've been trying to leverage legislation all sorts of ways, but they don't. So, this numerical way of treating people can be very dangerous, as you say, it's part of the equation. And that's what Osler said. Ultimately, it has to fit into what the patient's telling you. You can't disregard what the patient's telling you.

Back in the day when the Flexner report came, and that's the report that truly changed medical education, and that's what our book starts with, it was an Alliance of Corporate Medicine Academia, and the AMA. The AMA was the leader of this. What a lot of the people who created this said, talking to the patient is just going to be a distraction because they are too subjective and the numbers tell everything. This was German medicine at the time. Don't talk to patients. Just do a lot of tests, then you'll know what's going on. That's where we are now. You know, that was 1911. We're well past that, but we haven't changed a bit. We're still basically number focused. And unless those numbers fit, like I got to have a patient who's 90 years old and has a blood pressure of 180. And God knows they need every bit of that 180 or else their little narrow blood vessels are going to not get blood flow to the parts of the body they need them. So, if I lower the pressure, they get dizzy, sick, confused. I know that's a mistake. The numbers are not absolute. You just got to take each patient individually and see how things go. There can't be these protocols that are so broad. And That's why I say the anesthesiologists were actually wonderful to realize that. You know, they looked at me as a human being, not as a series of numbers, and that was wonderful.

Host 1: So, you're someone who's advocated for telling your patient's stories. I think that these stories have incredible value that we often gloss over, as you've mentioned. You just said you got a new-- was it a new hip or a new knee? Which one was it?

Dr. Andy Lazris: New knee. I'm old.

Host 1: So, tell us your perioperative story. How was your perioperative journey? We talk a lot about episodic care from the time of decision until the time of return to function. Tell us your story. How do we do in the perioperative space?

Dr. Andy Lazris: I was really happy with the anesthesiologist. When they cleared me to go into the operating room, I was chatting with them, I asked to meet the robot who was going to do my surgery, because I hadn't met the robot yet. It's robotic surgery. So, I was very disappointed the robot was not a very personable creature, just a box. But the anesthesiologists were the ones yaking with me, joking with me, you know, telling me it'll be fine. And I wish they were there afterwards, to be honest. When I got up to the floor, things kind of went a little south. But that's because they're extremely busy up there and, again, it's protocol. It became protocol too.

I'll give you an example. I have low platelets. Ever since I got the first COVID shot, my platelets plummeted. And they've been low. They've been around a hundred, but not horrible. But I was bleeding a lot into the knee and they gave me an aspirin. They said, "This is protocol." And there's where the critical thinking is. You don't give someone with low platelets who's bleeding an aspirin, but it just became just kneejerk protocol. And that's the kind of stuff that critical thinking would prevent. That didn't happen perioperatively. I think there was a little more thinking, and I appreciate what you say that you guys are the primary care. I wish you stayed with me afterwards. That would've been very nice. But, you know, fortunately, I got chucked over to other people.

Host 1: So, there's been a push for that. The idea of postoperative medicine is something that's actually had a lot of discussion in our world as anesthesiologist here lately.

Host 2: I think the Mayo Clinic has that model in Rochester, Minnesota, because the development of ERAS protocols and critical thinking. And I just want to add that that critical thinking saves money. My stepson, two years ago, he blew out his right knee and then, this year, he blew out his left knee. And we had a knee brace from the previous surgery and we said, " "Hey, can we just use the brace? We kept it, it still works." And it was protocol. You have to take the new one. It's sort of like, "But we have another one." And yes, not everybody saves everything from surgery. But I mean, if we have it, we have it.

The other thing I wanted to touch upon just briefly was that, you know, there is this division of labor in medicine. And when you finished an Internal Medicine residency, you did the clinic and you covered your patients in the hospital so that you knew the whole story. I think these days, right, once you finish residency, you have to make a decision whether you're going to go to the hospitalist track or are you going to go to the primary care track on the clinic? And then, how do you build a healthcare system where those two inform each other so that we do a better job taking care of these patients? And it's not the EHR. I know, that much.

Dr. Andy Lazris: The EHR is non-communicable, so we don't have the same EHR as anyone in the hospital, nor could we afford it. But you say there's a decision, I don't think there is. Nobody goes into primary care. Maybe they do where you guys are, but where my kids were and people I know in New York and the northeast cities, no one goes into primary care. But it's really the hospitalist or urgent care seems to be where people go. But the communication between us and everyone in the hospital is the critical part that's missing. And I think, at least where I am, when they went the hospitalist route, they just truncated that communication.

And my son's a hospitalist in Denver, before he goes for fellowship. And I ask him about these things. He says in the academic realm, it might be a little better. But certainly, where I am and which is not academic, they have no interest in this. We've tried and tried and tried. We used to have a texting system, because we know when people of ours go into the hospital. So, we had a texting system where we could tell them, "Look, we know the patient. Here's a couple things about the admission. We're here for you if you need us." And then, they would. It was really easy. It didn't take a lot of time. Then, they got rid of that and that there's no communication at all.

So at this point, I give my patients a slip of paper where they list all their medicines, all their medical problems, and have a big thing, "I will not do anything until you contact Dr. Lazris." So, I tell my patients' families I want to be contacted. I don't want them to do anything until they contact me, because too many of my patients have been harmed in the hospital from very zealous hospitalists who are young, just come out of residencies so they think they're all that. But they don't have any experience. And they don't want to talk to me because I'm the old guy, but I'm the guy who knows these people for a long time. And honestly, I've now bypassed the hospital, and put it on my patients to do this. So, that's how I'm doing it, sadly.

Host 1: So, you said something. We joke on here that we write these questions out ahead of time and then we leave them in like five minutes of the podcast. And you keep saying things that make me think you have kids-- a kid at least-- in healthcare, in medicine, and I have a son in college who's doing the pre-med thing that says he wants to go to medical school. We were at a conference this past weekend and people would look at me and joke, "Oh, you haven't talked him out of it yet?" And I get that, because we go through our careers in healthcare and we get frustrated about certain things. But at the end of the day, I still think I have a pretty dang good job. You didn't talk your kids out of going into healthcare. What advice did you give in that decision-making process?

Dr. Andy Lazris: I said. You can't get a better job than being a doctor. You know, you have security. you could go wherever you want. And you are actually helping people using both your critical thinking skills and science. But also, my kids majored in humanities also. I said, you'll get to know, the system, the people, you've developed strong relationships with people. My daughter, who's fourth year medical student, has had her moments of frustration as she watches all her friends get jobs, and she knows she has a long road still ahead. And I tell them it is a long road. And there's a lot of bumps and the system is terrible. It makes these kids crazy. It really does. Even now she's applying for residency and it's just everyone is basically stressed and depressed because of the system. And they had to take boards part one, boards part two, all these multiple choice, everything could destroy their career. That's what they're told, and yet they all seem to make it through. That's why I try to give them a lot of perspective and say, "Look, you're going to make it through. You're going to be a doctor." The old adage, you know, what do you call someone who finished last in their medical school class? You call them doctor. Because everyone becomes a doctor. And once you become the doctor, you could shape the world as you want. And I've chosen to do primary care and to be extremely interactive with my patients, and to buck the system as much as I can. They watched me do this for all these years. And they see I'm passionate. I am about taking care of my patients. And I think that really rubbed off on them.

And what other field can you do that maybe short of teaching? And teaching has the same problems with all this top-down regulation and people telling you what you can and can't say. So in medicine, you do have a little more autonomy. So, I encouraged it. I do hear the same story you do, "How could you let your kid go into medicine?" I'm like, "What else is better than medicine?" It is a great field still. So, I'm still happy as a doctor.

Host 2: I agree with the two of you. I still enjoy, you know, despite everything else that occurs each day, and it boils down to taking care of the patient. I still enjoy that privilege. And that's special, I think, when you look at what else is occurring in the economy.

Dr. Andy Lazris: It's a privilege. Yeah.

Host 2: Let me do one thing before my wife kicks me out of the house. But I forgot to tell everybody, the audience, how I met Dr. Lazris. And that is because, my wife, Sharon, writes for Epoch Times in the health section, and she interviewed Andy, I can't remember about what. But then, Andy said, "You got to check out this book A Return to Healing." And so, I picked up a copy and I read it. And then, that's when we reached out to you, because your story's important not only for us as anesthesiologists. I think it's important for all of medicine to hear. So, we've learned what you would tell your kids, or what you do tell your kids, what would you tell your younger self, Dr. Lazris? Any pearls of wisdom?

Dr. Andy Lazris: My younger self, I was not someone who just sat and let things happen. When I was in high school, I was causing trouble and I continued in college. And I was happy with that younger self. You know, I'm shocked because I just got a Master's in History at University of Maryland. I'm shocked by how the younger kids now just kind of buy what everything they're told. We were always questioning authority, they're quoting authority. And so, I really value my younger self. And I'm glad I was that kind of person and I actually wouldn't do anything differently. I think the road I took is exactly what I would take again, without any differences at all.

Host 1: This has been great, Andy. Thank you for doing this with us, man. His books are Curing Medicare and the more recent one, a Return To Healing. You can check all this out at andylazris.com. Andy, last message, you want to give our audience that you want them to hear before we sign off?

Dr. Andy Lazris: First of all, thank you so much for having me on and for all the work you guys do. But we are doctors. We are not number pushers. We are not all about creating diagnoses and diseases. We're about taking care of people. So as long as we keep that in mind, I think we're going to all do great.

Host 2: I can't think of a better way to end season two.

Host 1: There you go, Mitchell. We did it, brother. Another season in the bag. How are you going to spend your off season? This is when you just go to the beach and hang out for a few months, right?

Host 2: Find guests for season three.

Host 1: There you go. Fantastic. All right. Andy, thanks, man. This was fun. We will keep in touch in the future. Thank you for doing this for us. And thank you guys for listening to the Fresh Flow Podcast. We will hopefully catch you in season three. Thanks. See y'all later.