{"@context":"http://iiif.io/api/presentation/3/context.json","id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/iiif/0z70v8br5n/manifest","type":"Manifest","label":{"en":["Dr. Scott Colson"]},"logo":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","metadata":[{"label":{"en":["Rights Statement"]},"value":{"en":["\u003cp\u003eThis item is protected by U.S. copyright and related rights. It is being made available by the Center for the History of Family Medicine as its rights-holder for noncommercial use, including sharing and adapting the work. No permission is required for noncommercial use so long as attribution is provided. All other uses require permission from the Center for the History of Family Medicine.  Disclaimer:  The views presented in this broadcast are the speaker’s own and do not represent those of CHFM or the AAFP Foundation. The information presented is for general, educational, or entertainment purposes and should not be considered legal, health, financial, or other advice. \u003c/p\u003e"]}},{"label":{"en":["Date"]},"value":{"en":["2020-12-18 (created)"]}},{"label":{"en":["Language"]},"value":{"en":["English (primary)"]}},{"label":{"en":["Format"]},"value":{"en":["video"]}},{"label":{"en":["Subject"]},"value":{"en":["Covid-19 (topical term)"]}},{"label":{"en":["Keyword"]},"value":{"en":["Minnesota","family medicine","vaccine","PPE"]}}],"requiredStatement":{"label":{"en":["Attribution"]},"value":{"en":["\u003cp\u003eThis item is protected by U.S. copyright and related rights. It is being made available by the Center for the History of Family Medicine as its rights-holder for noncommercial use, including sharing and adapting the work. No permission is required for noncommercial use so long as attribution is provided. All other uses require permission from the Center for the History of Family Medicine. \u0026nbsp;Disclaimer: \u0026nbsp;The views presented in this broadcast are the speaker\u0026rsquo;s own and do not represent those of CHFM or the AAFP Foundation. The information presented is for general, educational, or entertainment purposes and should not be considered legal, health, financial, or other advice.\u0026nbsp;\u003c/p\u003e"]}},"provider":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/aboutus","type":"Agent","label":{"en":["Center for the History of Family Medicine"]},"homepage":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/","type":"Text","label":{"en":["Center for the History of Family Medicine"]},"format":"text/html"}],"logo":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","type":"Image"}]}],"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/collection_resource_files/thumbnails/000/204/645/small/ScottColson%2812-18-2020%29.mp4_1691678470.jpg?1691678472","type":"Image","format":"image/jpeg"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2334/collection_resources/104611/file/204645","type":"Canvas","label":{"en":["Media File 1 of 1 - Scott_Colson_(12-18-2020).mp4"]},"duration":1674.72,"width":640,"height":360,"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/collection_resource_files/thumbnails/000/204/645/small/ScottColson%2812-18-2020%29.mp4_1691678470.jpg?1691678472","type":"Image","format":"image/jpeg"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2334/collection_resources/104611/file/204645/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2334/collection_resources/104611/file/204645/content/1/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/204/645/original/Scott_Colson_%2812-18-2020%29.mp4?1691678470","type":"Video","format":"video/mp4","duration":1674.72,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2334/collection_resources/104611/file/204645","metadata":[]}]}],"annotations":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2334/collection_resources/104611/file/204645/transcript/48790","type":"AnnotationPage","label":{"en":["Transcript of Dr. Scott Colson interview [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2334/collection_resources/104611/file/204645/transcript/48790/annotation/1","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Crystal Bauer: Hello, Dr. Colson. Today is December 18th, 2020. Please confirm for the record that you are aware that this is being recorded and that you are giving your permission to do this interview.\n\nScott Colson: I am aware that it's being recorded, and you have my permission to do the interview.\n\nCrystal Bauer: Great. Would you please give your name in full?\n\nScott Colson: Sure. My name is Scott Colson.\n\nCrystal Bauer: And what is your present title?\n\nScott Colson: I'm a family physician and I'm also the president of our group, which is called Voyage Healthcare.\n\nCrystal Bauer: Where did you go to medical school?\n\nScott Colson: I went to the University of Nevada School of Medicine, which since has been renamed the University Of Nevada, Reno School of Medicine.\n\nCrystal Bauer: Okay. And what about your residency? Where did you attend?\n\nScott Colson: I did my residency at The Cedar Rapids Medical Education Foundation in Cedar Rapids, Iowa, which, unfortunately, as of June 30th of this year, ceased to exist.\n\nCrystal Bauer: Oh no. I'm sorry to hear that.\n\nScott Colson: A victim of graduate medical education funding, excuse me.\n\nCrystal Bauer: That's a shame. So, what was the world of medicine in family medicine like once you finished your residency?\n\nScott Colson: So, I finished my residency in 2002, so I've been out for about 18 and a half years. And when I joined my current group, we were still doing all inpatient medicine, outpatient medicine, we were following our own patients in the hospital. That wasn't happening all around the country, but in my neck of the woods, in the Twin Cities in Minnesota, it was still very common for family docs to round in the hospital and then go to clinic and spend the rest of the day in clinic, and take calls from the hospital all day. That has morphed, over time, into a system where, at least in urban and suburban areas, very few doctors still work that way. Most doctors, myself included, are in the outpatient world. My only inpatient exposure at this point is, I still do newborn rounding at one hospital.\n\nCrystal Bauer: Gotcha. And would you describe your experience in your current practice?\n\nScott Colson: Just my day-to-day life or-\n\nCrystal Bauer: Yeah. Your day-to-day; what you do on a daily basis.\n\nScott Colson: Sure. Well, we are an independent multi-specialty group, and I start clinic at 7:40 in the morning. On the days that I'm not newborn rounding, I see patients all day until last patient at 4:40 PM. Usually spend another hour or two hours after clinic, picking up all the pieces and all the paperwork, and charting and phone calls, and all that sort of stuff.\n\nCrystal Bauer: Gotcha. How has COVID-19 impacted patient visits at your practice, and maybe, I mean, if it's changed since the pandemic started, versus right now, what maybe that looks like as well?\n\nScott Colson: All of the above. Turned upside down. When COVID first started, Minnesota had a statewide shut-down for about six weeks. Obviously, as healthcare providers, we weren't shut down, but everything was shut down, and patients didn't really want to leave their houses. So, an average day in clinic for me is about 22 to 25 patients, and we were seeing five or six patients a day for probably a month and a half. I was really caught up in my chart work though, so, that was a nice benefit.\n\nCrystal Bauer: [inaudible].\n\nScott Colson: And I got home early. My family appreciated that I got home early.\n\nCrystal Bauer: Sure.\n\nScott Colson: For a long time now, at least in our regular clinic, we've been back to pretty much the usual schedule. I think that the biggest thing is that every visit, no matter whether it's a diabetes visit or a sprained ankle or a physical or a well-child visit, every visit eventually comes back to COVID, because everyone wants to talk about COVID, they want time to get my opinion about things, or they see me as their trusted family doctor. So, every visit is just a little bit longer, so we can have that two to five minutes to talk about COVID, and my thoughts on what's going on.\n\nCrystal Bauer: Sure. That makes sense. Has telemedicine impacted your practice at all?\n\nScott Colson: It has. We weren't doing telemedicine until the pandemic hit. I think that's true of a lot of practices, especially independent groups. We had thrown around the idea of telemedicine for a few years. There's concerns about quality of care and startup costs, and all those sorts of things. And there's nothing like a pandemic to make you change things. So, in addition to all of the COVID response things we did in the clinic, we also fired up telemedicine fairly quickly, and still to this day, I see probably two to five telemedicine visits a day, depending on the day.\n\nCrystal Bauer: Wow. What payment issues have arisen, related to the pandemic, for you?\n\nScott Colson: I think most of our payment issues have been volume related. I don't know that we've had a lot of patients who haven't been able to pay their bills, or insurance companies that have given us too much grief, but certainly, volume-wise, for several months, things were very low. Other than that, I don't think we've had much effect.\n\nCrystal Bauer: Okay. What issues with having access to testing supplies have you had within your practice, and are those issues better or worse right now, and do you see them getting better in the next three to four months?\n\nScott Colson: Frankly, it's all been a mess. Early on, we struggled with PPE access, gloves, masks, gowns. We couldn't get N95s for a long time. We still struggle with obtaining N95s. We can get them now, but we're still in a pretty high reuse for our clinic where we do all of our COVID work. We struggle a little bit with access to gloves and gowns and surgical masks, although that has improved significantly. I'm hopeful, over the next couple of months, it will continue to improve. But I hear everywhere, I mean, even our local hospital, I see them send out reports every week about where they are with ordering and what they're running low on, so, it's certainly not cured yet. Testing supplies were different. Early on, we couldn't do any tests. Once we were able to get tests, we were able to test very select few people. We could test us, our employees, healthcare providers, otherwise, we couldn't test anybody. And that, truthfully, has gotten a lot better over time. Upstate also has a lot of community-based testing options, so I do feel like testing has gotten a lot better month for it to happen.\n\nCrystal Bauer: You've talked about this a little bit, but could you describe more, how COVID-19 has impacted your current position?\n\nScott Colson: Sure. So, I practice probably about 60 to 70% as a doc, and I practice my other 30 to 40%. My wife would save my other 60 to 70%. As an administrator, I've been president of our group for about almost 11 years. We run our group with a seven-member physician board, plus our executive director, CEO. And so, truthfully, we have a dyad model where our CEO, executive director, and I, make most of the decisions. And it's been everything from PPE procurement to how do we keep sick people out of the clinic. It's a bizarre theory. We're here to take care of patients, but if you're sick, we don't want you in the clinic because we don't want you to visit other people. So, we started with testing outside, evaluating people in their cars, we had drive-up tents.\n\nScott Colson: As the summer came, it was 85 degrees with 90% humidity. We were starting to get sick ourselves, with all of the PPE and being outside, so we converted the office I'm usually in, and put up semi-permanent walls, and created one whole hallway into just our COVID clinic. We did that through the whole summer, and that worked well. We all rotated through. So, even if you didn't normally [inaudible] four locations, and even if you didn't normally work at our office, you still rotated through in the COVID clinic. We've been in a surge now for a couple of months, I suppose. And so, about four or five weeks ago, we converted my entire location to just COVID. So now, when I'm doing COVID and I'm doing evaluations of patients who are COVID suspect patients, I'm clean-shaven and I'm wearing my N95, and I'm at our location where I normally work, which is all just COVID evaluation. And when I'm not, I'm at one of our other locations doing my usual job.\n\nCrystal Bauer: Wow. So, big impacts for you.\n\nScott Colson: Yeah. Huge impacts. 18 and a half years, never experienced anything like this. And I think anybody in or outside of healthcare would say the same thing. I mean, this is unprecedented.\n\nCrystal Bauer: Definitely. Yeah. In doing another interview, actually, an older doc who's about to retire, compared this to the AIDS epidemic and said that he utilized a lot of his skills in when he was treating that epidemic to this current one. So, that was a little before your time as a physician, I think. But-\n\nScott Colson: It was. I was in high school during the AIDS epidemic. And actually in college, in the early 90s, I was always fascinated with the AIDS epidemic and took a class that was specifically just about HIV and AIDS, even in my undergrad. So, it's interesting to hear that parallel.\n\nCrystal Bauer: Yeah. So, how do you see COVID-19 changing the profession of family medicine?\n\nScott Colson: That's a great question. I was thinking hard about that one when you sent me the questions to review. I think that it has done a couple of things. I think it has solidified our place as a medical home for patients. And most of our older patients... I'm 48 years old, so people who are a little bit older than me, who have chronic disease, they're well-established with a doc that they trust and they follow. All of the younger patients, they tend to just go to urgent care or do telemedicine. They don't really feel connected to a single individual or a single location. And I think this has really driven people to seek out that primary care provider, that primary care physician who they get to know and they trust, so they feel like they have a place to always go to get their questions answered.\n\nCrystal Bauer: Yeah, that makes sense.\n\nScott Colson: And we didn't learn a lot about this in our training, back in the day, but I think that family docs have to put more focus on public health. We learned it, but it wasn't anything you really saw in practice. I really feel like we really are in a position to do the education and to really help promote public health ideals.\n\nCrystal Bauer: Well, that kind of leads into my next question, which is; what tools do family doctors need to fight this pandemic?\n\nScott Colson: It's a multifaceted question with a multifaceted answer.\n\nCrystal Bauer: Sure.\n\nScott Colson: I think the first is access to supplies like we talked about. Not having to worry about, \"Geez, we're running low on medium gloves this week. Everybody, switch to a different size.\" I think there needs to be funding behind what we do. I think that the insurers, unfortunately or fortunately, either way, we are beholden to insurers. If it weren't for them, we wouldn't get paid. And I think insurers need to recognize that we are an asset to medicine and to helping educate patients. That's something that's not truly recognized in what we do right now.\n\nCrystal Bauer: Right. What unique challenges do you face with COVID-19, and are there any other barriers or obstacles you've come across that you haven't mentioned previously?\n\nScott Colson: I think, what to do when we get sick, that's been difficult. Those of us in healthcare aren't real good about, \"Yeah. I'm not going to go in today. I've got a migraine, or I've got...\" Whatever's going on. We go to work all the time. We always feel like we're there to help the patient because that's our job. And one of the famous stories in my clinic was, about four or five years ago, I had a concussion. I was knocked out briefly on the ice. And two days later, I came to work because I had a schedule and I had to see my patients, and that's a terrible idea, by the way.\n\nScott Colson: I was sent home rightfully so, and I then stayed home to recover, but that's sort of the mentality we have; that we're supposed to just always be there. And so, it was challenging, and particularly as a smaller group, we have only about 300 employees and 60 [inaudible] providers. As a smaller group, how do you manage when one of us is out sick or five or six of us are out sick all at once? How do you shift the patients around, that sort of thing?\n\nCrystal Bauer: Yeah. That makes sense. So, learning self-care as a physician is more of a priority than it was, previously, it sounds like.\n\nScott Colson: It certainly should be.\n\nCrystal Bauer: Yeah. Well, you should be pleased to know I've interviewed students and residents, and both residents and students have mentioned mental health, their own mental health, and how much of a priority it is to them, especially now. So, I think, perhaps, starting as a medical student and resident, there's more of an emphasis being pushed on them that they need to prioritize their own health.\n\nScott Colson: That's good.\n\nCrystal Bauer: So, hopefully, maybe that trend is changing.\n\nScott Colson: I trained before the resident work-hour restrictions. So, I trained when you just worked constantly and all night and the next night as well, and had one night where I drove home, and I didn't remember driving myself home. I asked my wife where my car was. So, I'm glad that that's being ingrained in the younger doctors because I don't feel like that was necessarily taught very well when I was in training.\n\nCrystal Bauer: Sure. What have you learned most, through this pandemic?\n\nScott Colson: We need to be flexible. We need to be nimble and constantly be catching up on new information and distributing that information.\n\nCrystal Bauer: If you could start this year over again and do things differently, what would you change?\n\nScott Colson: I would stockpile PPE. I wouldn't. It's a little bit of a joke. People at the early... People not in health care, people everywhere, were stockpiling toilet paper early on, as you'll recall, and you couldn't find toilet paper at the store. It's only a little bit of a joke. I mean, I really think the PPE struggle has been significant. And beyond that, I think that even though my group is a fairly nimble group, and we have the advantage of governing ourselves, we still struggled with when to make changes and how to make changes, and at what timeframe. You go from always seeing patients, always making certain you're available for them, to \"Okay, how do I deflect people out of the office, but still manage them remotely?\" And I think we did a fairly good job at it, but I'm certain there are things we could have done better and maybe sooner.\n\nCrystal Bauer: Being in the practice, your ad, do you see any advantages that you had, being in your type of practice, and any disadvantages, versus other ways of practicing family medicine?\n\nScott Colson: Well, that's the only job I've ever had. I came to this job right out of residency. So, I don't know that I can come... I hear from other people who work for bigger health systems that it's more complicated, they don't have any say in what happens, they're sort of just told what to go do. I have a residency mate who works in Iowa, who just was told, \"We'll, you now run the respiratory clinic,\" and didn't really have any say in it. I think being in an independent group, being situated the way we are with our four locations, our multi-specialties, it allowed us to make changes even though we might not have been as fast as we always wanted to. It allowed us to be involved to make the changes. We also didn't have the capital that a big system would have, so there were struggles as far as when people stopped showing up for weeks on end, we had to lay-off staff and furlough staff, and really hadn't ever experienced that before.\n\nCrystal Bauer: Sure. So, it sounds like the capital was more the negative, the lack of capital, but the amount of control you had in your situation was probably the biggest positive. Is that?\n\nScott Colson: I think so. Yeah. That is very succinct.\n\nCrystal Bauer: Yeah. During this time, what do you feel you've done right, and why?\n\nScott Colson: I feel like we have... Well, let me ask this; do you mean me personally or our group?\n\nCrystal Bauer: Probably a little bit of both. Your group, probably, Yeah. Let's focus on that.\n\nScott Colson: I feel like our group has done a good job of educating our staff, educating our providers. We had a fairly loose organization by department. The internal medicine department would meet, the family medicine department would meet, [inaudible] department would meet. We didn't get together as a whole very often. We would have one social event annually that we did. We would have, sometimes, a second social event, but we didn't have big meetings other than shareholder meetings, owner's meetings. But not everyone is an owner. And those are really business-focused; \"How are we doing? What do we need to do differently?\"\n\nScott Colson: Like a lot of places did, we implemented what was initially nightly or three times a week, and now, we do them one or two times a month, web calls like this. We did them over Zoom, and we invited all of our providers to... \"Let's talk for 45 minutes or an hour about what's going on right now, what's changing, why it's changing, give us other suggestions of what else we should be doing differently.\" And we really got everyone involved, and it was a great way to have FaceTime with everyone, and get information out to people.\n\nCrystal Bauer: Yeah. Great. Is there anything that you feel the group, maybe, didn't do as great, and could you explain why?\n\nScott Colson: I feel like some members of the group didn't take it seriously at times. People wanted to still travel, people would get together in small groups for meals, for lunches. We did have one small COVID outbreak amongst several providers because they would go sit and have lunch together every day. And lo and behold, of course, one of them brought COVID in and we had a bunch of people out. So, I feel like, in spite of the fact that we as an administration we're trying to teach people what to do and not to do, maybe the message wasn't being received.\n\nCrystal Bauer: Gotcha. Could you speak about the people you've worked with most closely during this pandemic, and who has impressed you during this time, and why?\n\nScott Colson: That's a hard question. We, for-\n\nCrystal Bauer: It could be a lot of people. So, I mean-\n\nScott Colson: It can be. I really do feel blessed that we are this smaller unit, and we do work together very well. We formed what we called our COVID operations team. It's our medical director who's a family doctor like me, our CEO, executive director, our finance chair who's eventually going to take over the CEO role, and our top nurse, our director of nursing operations, and me. So, the five of us formed the COVID team, and we met all the time. We still meet all of the time to talk about things. And I was just very impressed with the dedication, the willingness to do research, all hours of the day and night.\n\nScott Colson: That's probably been one of the most challenging things. I've been in leadership for a while, and this was the first year that my wife has looked at me and said, \"You know what? You need to be done.\" And my wife's a nurse. She understands what the hours were like. She married me when I was halfway through medical school. But the constant research at night, phone calls, text messages, being interrupted all the time because people have COVID questions, she has said to me more than once, \"Yeah. Maybe you should be done being president of your group because I'm kind of tired.\"\n\nCrystal Bauer: Yeah. Makes sense.\n\nScott Colson: But truthfully, I feel very fortunate to work with the groups that I work with and I think they've all impressed me.\n\nCrystal Bauer: That's great. So, vaccines for COVID have just been approved for use in the US and are currently being distributed. Could you tell me your thoughts on the vaccines, and how you think this will potentially impact you as a family physician?\n\nScott Colson: This has been fascinating because it plays into how the whole response in our country has been politicized. We see people who are on the side of \"It's a hoax, and we need to open up the country,\" and then we see people who are trying to follow the science and trying to do our best to protect people. So now, as vaccines become available, I still see sort of this divide between those two groups. I'm frankly excited. I mean, I think vaccines are our only way out of this. At the time you and I are talking, we're over 300,000 deaths in America. I've lost count, but I think we're at 16 or 17 million cases in America. To get to herd immunity, they say we have to reach 70%. That's an incredible number of people. So, if we can vaccinate our way to herd immunity, we can save a lot of lives.\n\nScott Colson: I have studied the vaccines a ton, I've been waiting for the day that the emergency use authorization would be passed. The first one approved was the Pfizer vaccine, of course. And just yesterday, I got my invitation from our hospital system to sign up to get a vaccine. So, eight days from today, I'm going to get my first shot. I'm pretty excited about it.\n\nCrystal Bauer: That's great.\n\nScott Colson: Yeah. I know. Like I said, my wife is a nurse. She works at the local hospital, and she has not yet gotten an invitation. And I said, \"Well, I'll just wait and we'll go together. We'll have like a little hospital date day, and we'll go get our vaccines together.\" And she said, \"Absolutely not. You're going to get it the minute you can because you see way more COVID patients than I do.\" So, I signed up, and I'm very excited about it. And I think that setting an example is going to be helpful to get the message out. You see on social media the last two days, nurses and physicians and NPs and PAs rolling up their sleeves and sharing their pictures online, talking about getting the vaccine. And I'm hopeful that that is sort of thing that will help some of the naysayers come on board to say, \"You know what? This is safe. We really should do this.\"\n\nCrystal Bauer: Yeah. Great. So, perhaps, a light at the end of a very long tunnel, hopefully.\n\nScott Colson: I feel like I have hope, for the first time in several months.\n\nCrystal Bauer: Good. Moving on to some philosophical questions to wrap this interview up, what is your sense of where family medicine is going in the future?\n\nScott Colson: That's another tough question. The thing I love about family medicine is it's so multifaceted. You have family docs who still do inpatient and outpatient medicine plus obstetrics. You have family medicine docs in the rural communities who are also working in the emergency rooms. You see family medicine docs like me who are more in the outpatient world. I think our core beliefs are still to be that medical home for people. I just had an experience yesterday where a gentleman who I've known for a decade and a half, I take care of he and his wife, they're both very elderly, and they brought in a nurse from outside the family to come be his advocate.\n\nScott Colson: And she came in and she said, \"He's got all these different specialists, and nobody's really paying attention.\" And I stopped her and I said, \"I realize we just met, but you're describing my job. That's what I do. I am there to help organize all of this.\" And so I really think that there is that place for family medicine, for lack of a better analogy, to be the quarterback of a healthcare team for patients to be their advocate and make certain they're getting the care they need.\n\nCrystal Bauer: Any views on important issues in the specialty related to COVID-19 that we have not addressed, that you would like to share with us?\n\nScott Colson: I don't think so. Vaccine. Get the vaccine out there, please.\n\nCrystal Bauer: Love it. That's great. Well, if there are no last thoughts you'd like to add, I just like to thank you so much for doing this interview, and all of the good work that you're doing.\n\nScott Colson: Thanks. As I told you before you started recording, I'm a big history buff. So, I appreciate the opportunity to participate. So, thank you very much.\n\nCrystal Bauer: No problem.","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2334/collection_resources/104611/file/204645#t=0.0,1674.72"}]}]}]}