Why Health Care Treats Instead of Prevents w/ Dr. Barry R. Davis, Author, The Preventioneers

Welcome to Healthcare Rounds, the podcast where we explore the trends, innovations, and leaders shaping the future of healthcare. I'm your host, John Marchica, and today I'm speaking with Dr. Barry Davis, physician and author of Preventioneers. Dr. Davis has spent much of his career focused on advancing prevention in healthcare, challenging how we think about patient engagement, behavior change, and the structural incentives that continue to prioritize treatment over long-term health. In this conversation, we'll talk about what it really takes to move prevention from concept to reality, and what healthcare leaders need to rethink to make that shift happen. Dr. Davis, welcome to the program. Thank you, John. Glad to be here. So you've spent much of your career. I should uh full acknowledgement, this is the first time that we've met, so I had to do a little bit of research before. And I was just astounded how much work you've done in this area and really pushing for this prevention first mindset. And so my first question that came to mind for me was what was the inflection point that made you realize that the current system wasn't just imperfect, but really fundamentally misaligned? Well, there were a couple of times. One was uh during the course of working on these uh large hypertension clinical trials, um it came across to me that we do them, we present the results. Sometimes the results go into guidance, but does it really get uh translated and implemented? And uh one of our studies that we did, which was a big one, was called All Hat. Uh and after that was done, we decided that we wanted to do something more than just publish it and present it at meetings. We decided we wanted to do some translation and implementation. And uh we actually got a bunch of experts and uh they helped us uh find ways to try and move it from the sort of the side the lab to the bedside. And uh we we we we were somewhat successful in it. Uh the other point, I guess, was um when the pandemic started. And I saw that we had all this knowledge, and somehow that wasn't getting translated and implemented into action. And I said, What is going on? That's when I decided to write this book. So is it how do I phrase this? In thinking about prevention, is it is it a clinical challenge? Is it a behavioral challenge? Is it a system design challenge, or is it kind of all of those things? All of those things. I mean, you have to realize that actually prevention comes from the word uh prevenir, Latin, and it means uh before come. So you want to do something before it happens. And uh so it's a clinical challenge because you know, how do you deal with the patient getting them to follow your advice and so on? It's a behavioral challenge because the patient has to figure out how to do this, and it's a systems challenge because a lot of the things that involved in prevention shouldn't be individually so-called lifestyle things. The system or the environment should be such that it should actually make it easier for the patient to just do this automatically. So it's all of the above, and uh it applies, I mean, hypertension is a great example of this, but it applies to so many other areas. Uh, you know, vaccines, uh, screening, uh, diabetes, and so on and so on and so on and so on. So you've said that, and you're right about this too, that prevention is often misunderstood. So what do people think prevention means? Um kind of thinking about a lot of the maha, a lot of the the buzz around um of that these days. Um what do you think people think it is versus actually what it requires? Well, people think that it's um you just come up with a concept and you tell everybody about it and you're done. Well, no. It's it's a lot more than that. And and and prevention also, uh, you know, you bring up Maha. Uh that there are some things there that are that are good, and there's a lot of things there that are bad. But one of the things is that um with everything that we do, there's always some risk involved. But the question is is the benefits clearly outweigh the risks. And so for like vaccines, they are so well studied, so well um understood, so on and so on and so on, that the benefits enormously outweigh the risks. There's risks in everything that we do in life. Um but yeah, so that you you just can't. So for let's say for uh hypertension, you know, we we know that it's related to heart disease and strokes and kidney disease and so on. And we know that there are medications that can lower the hypertension, we know that there are lifestyle changes that can lower the hypertension, but just knowing this doesn't necessarily mean it gets translated into action. And that's the biggest problem with prevention. How do you translate it into action? Well, that that kind of raises when when you talk about action, how do you measure it? And I think about like you know, quality measures CMS is famous for, right? Um, blood pressure control at a certain level, or you know, HBA1C under a certain, right? But how do you measure whether you're succeeding at preventive care? Well, that's one there's where you you might start is that look at how many of your patients are under control, and you can define control uh by the latest guidelines. And if they're not under control, how many people are close to control, and so on. But then you also have to look at the consequences if you're not under control. How many people are suffering these consequences? How many are getting into the hospital? How many are having heart attacks, how many are having strokes, how many are having um uh uh kidney disease. So there is a way to quantify all this and look at this. But it's you know, those are the kind of easily measurable things because actually hypertension is associated with numbers. So in that case, you can quantify it. Sure, sure. You know, I've been thinking a lot about as I've been reading through your work and thinking about back to, I'm gonna say at least a dozen years ago when the accountable care organization concept was starting to be popularized. So the pioneer ACOs, right, and the initial MSSPs, right? And and I did a lot of interviewing around that time, and I met a lot of people at conferences, physicians, who um, there were lots that were on board and lots that were maybe skeptical. And one of the things that the common refrain that I heard at the time a lot was okay, you're gonna be judging me on all of these things, but what about patient accountability? What about the patient's responsibility in in um, let's say in reducing your blood pressure or reducing your cholesterol or getting your your numbers in line if you're a diabetic? Like we in other words, you can lead a horse to water kind of argument. Right. So to me, that that gets to the maybe the cultural side of things. But talk to me a little bit more about that, because I understand that it's probably still an ongoing frustration with physicians today. Aaron Ross Powell So the system it shouldn't just be up to the individual. Somehow the environment needs to change for not only for patients but for everyone, to make it easier to do things. I mean, in the case of, let's say, hypertension, there are lots of systems that are trying to be used to make it easier for the patients to follow what they're supposed to do. Uh there's all these um systems where they would have teams that would look at monitor a patient's blood pressure, maybe through the home blood pressure monitoring devices or apps, and have ways to nudge them. But then there are all these other kinds of systems. I mean, there's a thing uh was studying in barbershops for certain segments of the population to get them to uh control their blood pressure, um and and and to help with uh um their diet and so on. But I mean, like one of the things that's wrong with the system is there's too much salt in everything. Uh so you know, if somehow the system would change, which is, I guess this might be part of the Maha movement, just to reduce the salt content in every place and maybe make it more aware for everybody how much salt they're consuming. But there are so many things that can be done in terms of the environment. And I I completely understand doctors' frustrations with this. They they do stuff and then the patient doesn't listen. And and but there's a whole bunch of reasons the patient doesn't listen. I mean, some of them is just, you know, come on, you should be doing this. But others, it's it makes it difficult. The medication might cost too much. Um, the inconvenience of it, they may have side effects. Well, they need to know what those side effects are, and they need to be reported, and maybe they could things could be adjusted or something tried differently, or maybe the medications aren't really causing the side effects. That happens so many times, especially with uh cholesterol medications. But uh yeah, somehow all the stuff needs to be redesigned in some ways. But people are trying to do this. It's just that it's hard to, and this is part of prevention, it's hard to change the status quo. Yeah, of course. And and you know, I'm sure we're gonna get into talking about incentives. But my my biggest question, which you probably get a lot, um, and I I think about the times in my life, um, there have been a couple of blips where I've made major changes to diet or to exercise. And it seems like there was, you know, I don't want to be overly dramatic about this, but it seems like there was a tipping point or there was something that kind of pushed me over the edge to say, you know what, John, you got to lose about 20 pounds. Or, you know what, John, probably um, you know, you shouldn't be eating this kind of food, or um, you know, limit your wine intake, or whatever that may be. But it it certainly came from within, but it was a precipitating event. And and so it comes down to behavior. And so my my big question is what do physicians or what do people maybe get wrong about how people actually change their behavior, right? I mean, I'm thinking like there's a there's a book uh I remember reading years ago, it may have been from the 60s or 70s, How People Change by uh Alan Wheelis or something like this, really kind of dove into this topic. But isn't that fundamentally, if we're just talking about this one component of prevention, right? That that personal responsibility, how do people make these changes? What is it? Is there a commonality? Is there because we can talk about the systems, but how do people do in your experience, Dr. Davis, how do they do that? Well, okay, first of all, say I'm not a behavioral expert. But but uh so, you know, something like you said, something can change in their life to realize that, some personal thing to say that, you know, come on, I'm not I'm not doing this anymore. But um it shouldn't be that way. Somehow the the whole environmental system really needs to start moving in a different direction. I'm not saying you can just go from part A to part B immediately, but um you need to be able to sort of shift the whole trajectory. And as you just talked about, exercise and food, those are two just so fundamental things. And the problem is that uh it's so hard to deal with those. I mean, people in some ways, I hate to use the word addicted, but there are some things that we eat all the time that just keep doing it. It's like habit, right? It's really addiction. It's more like just, you know, you do the same thing over and over again, right? Uh get up and you have the same cereal or you have the same kind of thing. Some of the stuff tastes some of that stuff tastes awfully good. Uh whether it's full of sugar or salt or fat. Uh and and it and it what sort of a miraculous thing happened. It was like the with the blood pressure medications. You we we keep on ordering lifestyle, you know, lose weight and exercise. Well, people don't do that. Uh so they get on a pill and they take and it lowers their blood pressure. But still that didn't work. So now we're in this age of GOP1s where people can get on those and actually lose weight. Um, so much as this is uncomfortable, these are sort of miracle drugs in a way. But you don't want, in my opinion, I don't want the whole younger population to end up on these medications. I think it's sort of a little bit late for the older population. So this is great medicine for them. But somehow the system needs to change so that the younger people or kids don't go on this path to obesity. Uh so the we need to invest more in changing the environment. And as you just said, you know, maybe invest more in behaviorists and psychologists to figure out better ways for to nudge people to do better. Right. Well, it it I guess maybe that leads me back to this systemic because you're talking about a lot of these things as well. And, you know, a couple of other things that I think kind of get in the way, right? So traditional fee-for-service medicine. And and and the knock on that, of course, is well, you're just gonna do more procedures or you're just gonna try to see, you know, bill as much as you possibly can, which we know that the reality of that is probably not, you know, so much the case, or certainly minds can be changed. But how do you align the incentives on the health system side or on the physician side? How do you align those incentives and then track that to get to this prevention mindset and into the way that the system, and I'm talking specifically physicians and health systems, how how they can be much more preventive in their mindset, especially if they're not necessarily getting revenue from it. Right. Well, the the thing is to change the stream of that, but there are so many um interesting models that are trying to be tested out there for this kind of thing. Um if you want to uh get uh the cost down, you want to see um patients not come in so much and have be healthier. I mean, it's just incredible. I mean, there's what little if I can just do a little bit of history from the book, The Preventioneers. Um there's a chapter in the book about Sarah Josephine Baker, uh, who was the uh an incredible woman. She was at the turn of the century in New York City. When she started in private practice, she saw all the incredible things that were going on, the tenements of New York City. Children were dying at incredible rates. And uh she decided that she was going to go into public health in some fashion, and she ended up becoming head of the uh child hygiene bureau in New York City. Uh but she realized that the way to make these kids healthy was to prevent them from getting sick. So he invested in certain um things like these so-called they had milk stations where the kids could get pasteurized milk in those days. And uh she had nurses go out to the homes and tell them how they should be uh raising their kids, and she also recruited older girls in the family to help out the mother in certain cases. So she had a series of measures and it just changed the mortality rate for uh children under five incredibly over the course of a few years. So the idea is to um try and move upstream a little bit. You know, what's causing the high costs? Is it that you have a few patients that are using up all the resources? Is it that you have many patients that are using up a little bit of resources, and if you made a slight change, that would which would affect things? So you have to decide, you have to really investigate the data. Um you want to try and make people healthy. You know, if their blood pressure is not controlled, control the pressure, find ways to do that. If their diabetes is out of control, find ways to help them deal with that. If they're not getting to the clinic, find ways for them to be able to get to the clinic. If they're not eating healthy, find ways for them to eat healthy. These are very difficult problems, but there are some models that are trying to deal with these things. I mean, if you can just nudge it in a uh a little direction, the amount of savings can be incredible for not only for the health and welfare of your patients, but for the the systems themselves. Um and they could be rein, that money could be reinvested in doing other things which would bring even better returns. Um it's amazing the amount of studies that have shown that how much you invest in prevention ends up saving costs in the end. Yeah, I mean, certainly it's uh you know common sense, right? And I and I'm thinking that what you would probably say is that you there are different strategies to deal with that high dollar, you know, end of life or that kind of patient versus the multitude, as you say, a little bit at a time. Well, if you were able to nudge in one direction, that's a different strategy, right? Right. To be able to, and and that's where in my mind, everything, and I know you've written about this, but everything really aligns with the population health, we'll call it a movement. I know it's been done for many, many years, but in the last say decade, pop health is you know one of the big buzzwords in healthcare. And and of course, in public health, you know, uh centers for disease control and prevention and prevention, right? Yes, thank you. Right? You know, people that people forget that, or if you just say CDC for shorthand, right? And actually that makes me, and again, this is not this is not a political show. I try to actually intentionally stay away from those things. However, there are policy issues that because it's healthcare, because it's you know, is it five trillion? I mean, a lot of money that we spend on it here in this country, then then it does kind of go into that realm. And I would I'm just curious about your are you concerned about at least proposed cuts that will affect CDC, that will affect public health. Oh, tremendously concerned. I mean, first I was concerned before all this happened because I think that the way we spend money on on research needs to be shifted a little bit. We spend a lot more on looking at stuff for treating and for curing, and we need to spend a little bit more on preventing. Because I think you get much more bang for the buck uh with that. But yes, you by you're you're cutting, yeah, there's there's waste and everything. But you you just like you're throwing that the expression you're throwing the baby out with the bathwater. It just uh this will affect so many things that could happen. I mean, you know, not to get political, but the the just cutting out USAID, which actually had projected a lot of soft power for the United States, but it's resulted in so many um premature deaths around the world just for spending a little bit of money. Um one of the major achievements of um this isn't USAID, but one of the major achievements in the world is this. Eradication of something called guinea worm disease. There used to be like millions of cases, and now there's like three or four or five, under ten. All because a great effort was made to eradicate the disease. And it wasn't eradicated through a vaccine or a treatment, it was eradicated through procedures. A great deal of effort went into eradicating smallpox. Smallpox no longer exists. So we don't have to worry about that one. Right, right. So if when when thinking about I'm trying to think of a system, if you were to to design things sort of from the ground up, what what would change with this preventione here? And we'll get to that, but what would what changes from a systemic perspective? And I know you've been talking about some of this throughout our conversation, but if you were designing something, maybe in thinking about in terms of insurance plans or other things, like what would you what would be sort of your top few list of things in designing a system that was more prevention oriented rather than cure-oriented, curing the sickness kind of orientation? Right. So in in the system, you would try and look at what are the the biggest preventable harms that we suffer? Um whether it be cancer or heart disease or um opioids or auto accidents or not to be political, but even gun violence. Um the uh what are one of the biggest ones and and what are the proven ways that we might um deal with those things? But then so you you have this part of recognizing the harm, and you have this part of gathering the evidence, but then you have the really tough part of how do you translate that evidence into something translatable? How do you be able to do it such that it can reduce these preventable harms? And then the really, really tough part is once you find that, how do you implement it? How do you make it such that it's going to become just a part of the system? I mean, I do talk about this in the book. A perfect example of that is auto safety. Um there was this huge preventable harm. There's this whole chapter about these doctors, these are literally doctors, a neurosurgeon, a plastic surgeon, an ear, nose, and throat doctor. These are the people who you would think would see auto injuries. You know, your face gets messed up, your head gets messed up. Um and they decided that they something needed to be done, and the light bulb went off in all their heads at various times, realizing that it's yeah, it's the it's the person driving the car and all those things, but maybe you could design the car better such that if even if they got an accident, that all this damage wouldn't be done. And that led to things like seat belts and padded dashboards and retractable steering wheels. And now we have these even better things, you know, the modern car in the last 10, 15 years that has these uh cameras all over it and these automatic systems was automatic braking and so on and so on. Um so, Ken, that's what I was talking about at the very beginning. This is a perfect example of that, in that, you know, why don't you change the driver's behavior? Yes, we should, of course. And we should change the design of roads and safeties and signals and so on. But let's help design the cars better so that even if you do have an accident, you'd have less damage. So this is so you want to, and and it became part of the culture. If people probably don't remember that, it took a long time to get seatbelts into cars. And then even when seat belts were became a regulation from the government, people weren't using them. Yeah, people would sit on them, they would do and then the car manufacturers put the warning signals in the cars, you know, you the thing go goes off. And then you get a ticket now if you don't buckle up. But I I I you know it was most interesting to me. I was on a podcast with uh recently, and um is the emergency uh pediatric physician, and he told me that it's incredible the number of kids he sees in the emergency room that have car injuries, and the number one reason they have them is because they weren't wearing their seat belts. So these are the things that you know we have to find ways to make it part of the environment. You know, there's all those things this kid should have been wearing these seat belts because the alarm goes off, and if with their parents and they they get stopped by the law, they'll they'll get a ticket and so on and so on. But maybe there are other ways. So you have to just drill down. So you have to make this translation into this implementation, which will um be part of the the culture and the system. I mean, another example of that is to me that is somewhat obvious is smoking. It took a long time to sh recognize that smoking was related to cancer and it and other diseases. It took a long time to show that uh to gather the evidence. It took me a lot of resistance, and then it took a long time to slowly bend the curve. But smoking still exists. Tobacco is still on the market. Um but the the prevalence of it has just dramatically dropped. Um so it's got to become part of the culture. I mean, it did become part of the culture. We got them got it off the TV. Uh we put warnings on the packages. Um it's now even some countries are trying to figure out uh ways to to ban it altogether. Uh that's that's gonna be really tough. But you we we develop these laws that uh kids aren't supposed to get them. They find a way around it, but and so on and so on. It's it's not even part of the movies most of the time. It used to be part of the movies, but you think back to the 50s and 60s, if you watch old films or something, people are smoking all the time. Now they're still smoking in movies, but not so much. Well, there's a whole line of literature. I mean, I remember um back at Dartmouth, there were some researchers there that really focused on um the effects of smoking in movies and cigarette adoption um among teens and was really kind of on the forefront of you know getting these kind of warning labels and things in in movies to ensure that those those things, at least the parents would know that those things were being shown. People were and and over time that that smoking was reduced. Um I'm wondering how you feel about uh we're a little bit off topic here, but it well, we are and talking about prevention. That's okay. How you feel about that's social media, right? And and the latest cases that have been coming out. You brought that up because I've done some broadcasts and written some op-eds about social media. I mean too, that's that's the new sort of they call it the the tobacco moment, but that's sort of the new thing in that uh we've seen this sort of harm that's been happening, especially to the kids, uh, with social media and being on the phones all the time. And year after year, people have been complaining about it more, researchers have been studying it more, providing more and more evidence. Um, and yet it's still there. But what's happened is that, let alone that what they call the tobacco moment, where the these people want a suit against the large media companies, like the suits were won against the tobacco companies. But there's also this increasing number of states that are banning phones from schools. I don't know, it's up in 25 or something states that may have already banned phones from school, and more and more are getting on the bandwagon of doing this. And the reports from the schools is just incredible. The kids are, you know, actually paying attention, they're actually interacting with their peers, there's less bullying, there's less depression. So this is a social experiment that's happening before our eyes. But when you see this preventable harm and you gather evidence, and then you try and translate and implement something on scale, maybe some good can happen. Well, it seems like people are paying attention, um, certainly with uh finally with the issue with kids. I watched it. I have four kids. I watched them in the earlier days of Facebook and and and uh wanting a phone earlier. I've heard people giving phones to their kids when they're five years old, um, six years old, which sounds absolutely insane to me. But the other thing I think that doesn't get talked about as much is what about the effect on us as adults? What about the effect on discourse? Yes, it's uh you know, I'm sure there's been stuff written about this, but it's kind of common sense, maybe, to say that these kinds of conversations that happen online that they become more vitriolic, that they're they're more divisive. Um because the so you know all the good things, it just I swear I've had this conversation the other day about the good and the bad of technology, right? There's the the great things that can happen and staying in touch with your friends, right? Yes, all that and then the negative side of things which may be contributing to our divided society today. Right? Yes, a lot of people have written about it and talked about it. Uh, you know, this you hide behind a um you say things that you wouldn't say to somebody's face. Um it's easier to just blah, blah, blah, blah, you know, online, right? Right. So uh it is affecting adults too. Um, I guess the one saving grace may be is that because we're adults and hopefully we're more mature, we have some more self-control. I'm not saying that's necessarily true, but uh it's very bad for kids because they don't have that at all. Uh they're just trying to grow up. Of course. Yeah, we've we've been doing a lot on is what one other question on value-based care. We're kind of working on a series on the current state and future of value-based care. Where do you think, how do you think that we're doing in the in the sense of, and not just value-based care in general, but where prevention falls within things like bundled models or population models or accountable care organizations, things that have really been popularized and that that the government has been trying out and that private insurers and employers are trying out. How would you say that that that movement is doing in terms of a prevention mindset? Um I don't keep up with it that well, but my feeling is that it's moving in the right direction. I feel that it should be moving further. Uh whatever we apply to, I mean, there's some easy picking fruit for this, like the hypertension or diabetes. But there's probably so much more that can be done across some of the most prevalent diseases, um, and ways that can be um found out about how to deal with them, how to translate that evidence into some sort of translation of uh trying to prevent this on scale and uh and finding ways to make it um part of the system, whether it be uh something that the patients would do, or something that the system itself would make it easier for the patients to do, or something that everybody would believe, some part of the culture. Yeah, it's it's it just needs to be emphasized more. I mean, one of the reasons I I wrote the book was it was gonna be a book about all the things we've discussed. And I started to do that, and and I have a uh mathematical and statistical background, and I was gonna fill it with all these charts and figures and um numbers and so on. And and and somebody and I said to myself, nobody's gonna read this, nobody's interested in this. So I changed the whole force of the book, and it just it tells the stories of the people who worked on prevention, what their lives were like, how they experienced these preventable harms were just part of their either where they lived or where they worked. And it just became, they decided that I have to do something. This is can't go on. And they came up with a way. They weren't all successful, uh, but at least they tried. Sure, sure. Well, and then just kind of ending or wrapping things up, I know we've been looking at the clock and I didn't realize how much time in fast. Um, me neither. Well, just like we're going so fast. So get but to that, you you frame preventiers. It's almost it's almost like a new kind of leader. And and so when you think about that, let's say that that you were new CEO of a health system. I know you spent your career at you know University of Texas. New kind of CEO comes in, wants to have this mindset. What would those characteristics look like? What would they, how would you describe that leader as a preventioneer? Um, well, preventioneer was a sort of amalgam of the words prevention and pioneer, but I also consider people who are sort of prevention crusaders or champions or advocates, preventiers. Somebody who comes in and says, Well, where are we spending all our money on? Is there a way to um do something different, move upstream? Um, what are the preventable harms that we deal with all the time in our system? And what are the ways that we can sort of limit those preventable harms? And how can we shift the system such that we can translate the evidence that exists for those preventable harms to um make them less, you know, do something, um, whether it be with the blood pressure or the diabetes or the smoking or the vaccines or the cancer screenings, and the list can be quite long. But there there are probably a whole host of other things. I mean, one example might be just hospital infections. You know, what's what's causing all this? Um, and they should have a uh at least a person who might be like sort of like the chief prevention officer for their system to identify all these and to find out ways to lessen them and then find out ways to do some implementation uh to create uh teams or systems or whatever, in terms of uh trying to um implement it to be part of their system so that these things would diminish, diminish over time. Yeah, the to me the the the most obvious example of that is uh the um Atul Gwande and the checklist manifesto, right? And that the the surgical checklist. Um one of my favorite TED talks, um Dr. Gwande, um, we'd like to have you on the show. So just letting you know. Like to have you talk about that. But right, that's to me, that's that's that mindset that just really is crystal clear. Um and so Yeah, that checklist is is all about prevention. Just go over it one by one and look what you're going to prevent any errors. So um I guess and and but before we do our lightning round, which I always like to do at the end of these, a quick word or phrase when I in response to what I say. Um if listeners can take one idea away from your work, from the from preventioneers, the book, one solid idea, what would you what would you tell them? And I guess the follow the uh follow-on to that too is if people need to get a hold of you, what's the best way of doing that? Oh. Okay. So when you say listeners, are you talking just healthcare people or just the general population? Um let's start with healthcare people. Because I think the vast majority of our listeners are probably healthcare people. Okay. So yeah, so the thing I say is the prevention mindset is such that you think to yourself, what's going on in my life, in my job that's uh preventable? What kind of harms are there that I see that uh something can be done about? And you can just sit there and frankly make a list of five or ten of those things. And then why are they not being prevented? What is there evidence that something can be done to do this? And then think more deeply about that. How do you translate that into something that can um actually be implemented to change it? But you're just seeing what are the preventable harms you can see around you. Sure. So the second part of that is if people want to reach out to you, Dr. Davis, what's the best place to find you? Sure. Well, they you can find me online, and um there's a contact sheet on my um um website. There's also they can reach my email, which is uh Barry RDavismd at gmail.com. Um those are probably the two best ways to reach me. We'll make sure to include all of that in the in the notes. All right. So but before before we go, um so quick answers, first thing that comes to mind. All right. All right. So here's here's our quick lightning round. One behavior change, I know you're not a behavior guy, but one behavior change insight that preventiers or or leaders should really understand about prevention. Um that you convince the the patient that that it's in their best interest, and you talk to the patient about what can be done uh in their life to make this easier. Maybe they can suggest something and then you can help out with it. Great. Um thing with again prevention or mindset, one thing clinicians should stop doing tomorrow. Uh stop always thinking about how do I treat, how do I treat, how do I treat, and maybe start thinking about how do I prevent. And then finally, one thing that health system leaders should start doing immediately. Right. Well, I'll go back to what I said before. They should think about the preventable harms in their system, and maybe even think about the idea that I mentioned earlier about having a chief prevention officer that will help them with that. Excellent. Well, Dr. Davis, thanks so much for spending some time with us today. It's a wonderful topic. I wish you the best of success with the book and your talks and your travels and everything else. And I hope we're we're able to keep in touch as well. So thanks again. Thank you, Jen. I appreciate it so much. It's been great talking to you. And you too. And thanks to all of you for listening to Healthcare Rounds. And if you enjoyed this episode, make sure to share it with a colleague and leave us a review. It helps others find the show. And you can find more episodes on your favorite podcast platform or by visiting our website. I'm John Marchica, and we'll see you next time.