{"@context":"http://iiif.io/api/presentation/3/context.json","id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/iiif/mg7fq9rk82/manifest","type":"Manifest","label":{"en":["Dr. Tessa Rohrberg and Dr. Lynn Fisher"]},"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":["2021-03-19 (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":["Kansas","Wichita","family medicine","social media","vaccine"]}}],"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. 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Rohrberg and Fisher interview [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2334/collection_resources/102721/file/202341/transcript/47171/annotation/1","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Morgan Weiler: So if you both would just tell me your name and then full title, please.\n\nDr. Fisher: Yes. So my name is Lynn Fisher and my full title, I'm a medical doctor and I'm assistant professor in the department of family and community medicine in Wichita. I am the director of the rural preceptorships and also serve as an assistant to the family medicine clerkship director.\n\nDr. Rohrberg: And I am Tessa Rohrberg, also MD. Assistant professor at KU school of medicine in Wichita, department of family and community medicine. I am the director for sub internships and electives in family medicine, and also an assistant director on the family medicine clerkship.\n\nMorgan Weiler: Great. And then where did both of you attend medical school?\n\nDr. Fisher: I attended medical school at the University of Kansas. I did the two and two track, so first two years in Kansas City and then the last two years, the clinical years in Wichita.\n\nMorgan Weiler: Okay. And then if you want to answer Dr. Fisher, where did you attend residency and then Dr. Rohrberg can answer.\n\nDr. Fisher: Yeah. And then residency, I completed in Greeley, Colorado at North Colorado family medicine residency.\n\nDr. Rohrberg: And I attended medical school at the university of Kansas. I also did the two and two track, two in Kansas City and then finished in Wichita and I attended residency at Wesley family medicine in Wichita.\n\nMorgan Weiler: Great. And then can both of you speak a little bit about your current positions and then what you do on a daily basis? And I know you guys also change it up weekly. You guys are very busy. Can you talk a little bit about that?\n\nDr. Fisher: Yeah. Currently I split my time between duties at the med school and Wesley Family Medicine residency. I work with the family medicine clerkship. When every group of students go through the clerkship, there are certain activities during those eight weeks I assist including giving lectures on geriatric functional assessment and ophthalmology.  I also lead a session on one of the SPs trainings that the students do on geriatric functional assessment [inaudible] And then I have my duties with the rural placements, so helping to arrange where students doing the family medicine clerkship rurally want to go and the required fourth year rural clerkship for students wanting to this in family medicine.  When students are on the rural clerkship rotations, I do a touch base call during the middle of that with them. Then there's other things at the med school that I'm involved with.\n\nDr. Fisher: So I'm on the admissions and selections committee for the medical school. I'm part of the KUMC diversity equity inclusion cabinet, and also help with the Wichita component to the diversity equity inclusion, and we have our own programming that we do. Then I'm also part of the rural health task force that the med school is currently doing, and there are some subgroups to that that I work with including the center for rural health task force, undergraduate medical education task force, and then there's also a data sub committee task force that I attend to provide an input from the Wichita perspective. And when we are not busy in other meetings that Tessa and I do, then at the residency I spend a couple half days a week supervising the residents.\n\nDr. Fisher: I have a half a day a week that I provide my own patient clinical care. And then occasionally throughout the month, I'll have a couple of times that I go to the nursing home to provide care with the residents. I have a weekend every two months and a number of night calls that I do for both inpatient medicine and maternity care call. And then Dr. Rohrberg and I every two months will take inpatient medicine responsibilities for the Wesley Family medicine residency and co-round with the residents and take care of the patients. I think that's a pretty exhaustive list. I know that there's more things that Dr. Kellerman and the department get us involved with, but that's the best I can do off the top of my head.\n\nMorgan Weiler: That's impressive. Dr. Rohrberg, if you want to talk a little bit about what you do.\n\nDr. Rohrberg: I feel like I have to catch a big breath before I follow that. So I would say, to echo what Dr. Fisher said, my time is split between the KU school of medicine on the Wichita campus and through Wesley family medicine residency program for clinical time. On the school's campus, I primarily work with our coordinators to set up students, mostly fourth year students in family medicine sub internships and electives in family medicine. We have a variety of electives that they can do in two or four week increments. We also work with first year and second year students on their SER enrichment week electives and do some summer electives as well. Bridging off of that, I help serve as the liaison between Wesley family medicine and the medical school as the sub internship faculty.\n\nDr. Rohrberg: So I help orient students when they get to Wesley for their sub internship and help coordinate their evaluations from different faculty and residents through that rotation. And then similarly as Dr. Fisher does, we have mid rotation check-ins on the sub-internships to make sure that students are getting everything accomplished that they need to. And then a variety of clerkship activities. I have not yet done any didactics with the clerkship, but I do help with the standardized patients and giving feedback to students. And will be taking over some of those didactics soon.\n\nDr. Rohrberg: We do a variety of different didactics, so depending on the time for one hour lectures for residents during their didactics or giving other lectures. I lead a larger elective that is dermatology in primary care for fourth year students, and we offer two weeks in the fall and two weeks in the spring that we coordinate workshops and didactics for that and clinical skin screenings. We do some writing as faculty. I've written a chapter for Conn's current therapy on delirium. We present at symposiums for different national conferences. We've participated in some research projects. We're working on one looking at match data right now within our department on who matches into family medicine.\n\nDr. Rohrberg: So there's a lot of projects that are ongoing. The other part of my week is clinical and I do two half days of supervision in Wesley family medicine residency clinic. I have a half day of my own clinical care and then a half day a week usually, of nursing home care with the residents. And then similarly, take overnight call for inpatient medicine for the residency and cover inpatient medicine rounding once every two months and weekend call. Let's see. I had thought of something. Both of us are co-advisors for the Family Medicine Interest Group, and Dr. Fisher is the advisor for the Rural Medicine Interest Group. We both volunteer for Jaydoc when we can on Saturdays. Gosh, I think that's it!\n\nDr. Fisher: I know. The other thing you do, Tessa, is you lead a small group, like a PBL.\n\nDr. Rohrberg: Oh yeah. PBL. So that's right. I do first year PBL and coaching as well. So I do that once a week as well.\n\nMorgan Weiler: Very cool. What unique challenges did you and your practice face... And I guess this is interesting because you guys do more clerkship stuff. So talk a little bit about just the challenges and start from the beginning and then walk us through that with the positions you all serve in.\n\nDr. Fisher: Sure. Tessa, do you want me to go first or do you want to go first on this one? Either way. I'll go ahead and start. So from a clerkship or a student perspective, obviously when COVID first started, we had to quickly shift from students who were going out and spending time with preceptors to trying to develop some sort of virtual online format. And Dr. Rohrberg and I spent a lot of time with Dr. Kellerman and our course coordinators at the school just brainstorming what that looks like? How can you possibly help deliver a family medicine clerkship that doesn't involve being able to spend time with patients as we know it. So I think that was one of the biggest challenges initially.\n\nDr. Fisher: And do I feel like it was as good? No, but I mean, I think that we came away with definitely ideas and projects that we had the students do that we thought had a lot of value, that we've actually expanded. Like things that were kept in the clerkship for future student rotations, things that I've had the rural preceptorships students do when they had to be on virtual rotation.  I think Dr. Rohrberg probably had some of her electives doing some of the same things. So I think it just, it opened our eyes to what some additional resources are, like podcasts, webinars, different readings, just different websites that were available to access information about health of Kansans broken down by counties, that I think we feel like have been valuable to keep on sharing with students.\n\nDr. Rohrberg: Yeah. Online, like patient cases, even so much as online workshops as how to do suturing or different procedures and videos of how to do that. Different things like that, that you could utilize. Even the Pocus procedures, things that you can perform on your own patients or students could do self-study type of workshop things. I do think something that we also faced as a challenge or was something unique was the telehealth exposure. I know that you've probably found that a lot of practitioners just didn't have a great understanding of how telehealth could be maximized. And in our residency clinic, it was definitely a challenge in getting patients switched to telehealth, especially because we have somewhat of an underserved patient population.\n\nDr. Rohrberg: And so technology, internet connection, those were concerns. Could it be a telephone visit? Did it have to be a video visit, using the software that the EMR wanted you to use? Or could you utilize something else and then do those. In terms of residents counting those as patient experiences, do those count as patient encounters or is it just additional care that they're doing? And then at the nursing home, we had a huge challenge because our care was limited as far as resident physicians and students being able to go. And then when nursing home residents became ill with COVID, they were quarantined and we tried to transition and do window visits or FaceTime visits. And so those were some other challenges that we faced in how to teach nursing home care doing virtual visits.\n\nDr. Fisher: The other thing that in the clinic itself that posed challenges for workflow was if somebody made it into the clinic that ended up being somebody that you were concerned might have COVID, we couldn't swab them in the clinic because you had to shut down the room for 40-minutes, or it was some very specific time, but that room could not be used. If you had a lot of residents or a lot of physicians in the clinic seeing patients, to have a room taken out of commission for that long a time could really affect patient flow. And so we ended up having patients come to the back parking lot, and then actually the faculty were the ones that were to go out and swab the patients. Normally, you're used to your nursing staff or your MAs being the ones who would swab patients for strep throat or for the flu or things like that, and then it became us being the ones who did that. We would don the protective equipment, the mask, the gowns, the gloves, face shields and go outside and do that. \n\nDr. Rohrberg: Yeah. And I think it's an attempt to conserve PPE, is the primary goal of that, but yeah. And you would always have patients that you have to do questionnaires and change the whole check-in process. And I still think patients would get by that, could have done a telehealth visit for COVID symptoms, but they wanted to be seen in the office and then you have who's exposed during that encounter and does it count as an exposure and, so forth.\n\nMorgan Weiler: Interesting. You all talked about a couple of them, but what barriers did you face when COVID started out and you were trying to make things work in the clinic and also in the clerkship?\n\nDr. Rohrberg: I think that one of the main obstacles that we faced was trying to meet the requirements and fulfill the objectives of a rotation while also satisfying students' needs and their wants as well. I think that was an obstacle because clinical experience just couldn't happen. And so we had to balance what students desired to get out of the rotation with what was feasible and also trying to meet their objectives in the same manner. So that was a big obstacle. I think the barrier or obstacle, I suppose, was also just the preceptors that were available. I think if there was an opportunity for clinical exposure or telehealth opportunities, the amount of preceptors was limited, much more limited than it was in non COVID times.\n\nDr. Rohrberg: And for instance, some people weren't doing any clinical work or couldn't go to the hospital for their rotation, whereas maybe direct primary care was a good rotation to do because students could... You can do direct primary care without having to necessarily physically see patients all day. Physicians in DPC already use a lot of technology. So that was something. I don't know. Do you want to expand on that, Dr. Fisher?\n\nDr. Fisher: Yeah. I mean, I think you mentioned preceptors or health systems. We had maybe some willing preceptors, but maybe the hospital system they worked for said, \"Gosh, we're worried, we don't want to accept a student right now.\" So sometimes it's not always just the preceptor that has the final say as to whether or not you can accept a student for a rotation. And then just other practical things, it's like people having difficulty with understanding, hearing with masks, being aware that we have people who are lip readers, people who are hard of hearing and when you take away people's ability to see your lips, sometimes that was a barrier, an obstacle when we were in patient rooms with people.\n\nDr. Fisher: I think something that Dr. Rohrberg and I definitely talked about, just the injustice sometimes of seeing the limitations for patients to be able to have family members there with them when they were really sick. There were times where there were no visitors allowed unless people were actively dying or in hospice care. And so I think that was also something that was a huge barrier to what we normally see.   Families and support systems play a huge role in a patient's ability to get better sometimes and that support system wasn’t available.  [inaudible]\n\nMorgan Weiler: Do you think we're going to see a spike in mental health issues, mental health crises, long-term effects from some of those things you mentioned?\n\nDr. Rohrberg: Yes, I do. And I think we're going to see it in patients, caregivers, and providers. I think that providing health care didn't stop in COVID and while there are challenges with losing jobs and we're fortunate we still have our jobs, we often, maybe not me directly, but healthcare workers did face a lot of the burden in frontline working. And there's a, I think a huge risk for post-traumatic stress disorder and anxiety disorders. And also just trying to find that balance between wanting to work and help people, but also trying to protect your family and yourself. And it's really amplified in a pandemic for sure.\n\nDr. Fisher: Yeah. That's actually what I wrote down. I think that we already had issues, like the healthcare system wasn't adequately addressing mental health needs before and this pandemic, that's the word I wrote down, it amplified the strain on our system. And again, the other thing I wrote down is I do think that you're going to see a lot of healthcare workers with PTSD. I mean, I think I just saw something today or yesterday about a nurse who was traveling for the pandemic and estimates that he's probably seen 3000 people die. I mean, who sees 3000 people die as a caregiver? And so how can you not come away from that being affected by it? So I really do think that we will have to figure out how to better address mental health, not only for patients, but also for the healthcare givers.\n\nMorgan Weiler: Yeah. So I want to ask next, how did both of you manage your personal life, professional life during the COVID pandemic? How did you stay safe mentally, physically during all of this?\n\nDr. Rohrberg: I was still breastfeeding and pumping when the pandemic started and I was so anxious that I had a duffel bag and a complete set of separate clothes and was washing in between pumping parts and trying to change my clothes. And I think that we had a scrub washing service at the clinic and we were leaving everything in the car or in the garage when we got home and trying to really take everything off. My husband, if I was around sick patients, requested that I would just go directly to the shower when I got home and it was very anxiety provoking. And then I think also my son was still in daycare and so every sniffle that he got, we were anxious, should we separate from each other? Should we quarantine?\n\nDr. Rohrberg: Can we send them back to daycare? There was just a lot more questioning some of the normal things. I think that one thing that our job allows us to do better than perhaps in private practice is that we can have an ‘off’ time. And I do feel like when I'm not on call, that I am able to turn my phone off and have that time with my family, and have some personal time. But I will tell you lots of journaling, trying to read, trying to exercise, drinking lots of water when I can, staying hydrated has really been helpful. Those are some things that I think of. Trying to get sleep when I can, just trying to do some of those basic self-care needs which are really challenging in regular times too.\n\nDr. Fisher: Yeah, for me, it turned into a lot of running because I used to go to the YMCA and when the pandemic hit and gyms closed for a while, and I still have not returned to doing that at all. And I have used the school's basement gym a little bit here and there, because a lot of times you can go there and there's nobody in there. But it really turned into a lot of running outside for Preston and I. And then food, Preston loves to cook, I love to eat the food. We ate-in a lot, trying a lot of new recipes which was fun. I had started watching a little more TV. I can't say that I watch a lot of TV, but I did actually subscribe to Netflix and have watched a few shows.\n\nDr. Fisher: And then the other thing that was really nice for us is that we had a small group of friends. There were about six of us who we really trusted, would wear masks, would not engage in any sort of behavior that would be high risk, like being in public spaces without wearing masks. And so we had a dinner club throughout this whole pandemic, and when we are in each other's homes, we wear masks. I think now most of us have been able to be vaccinated except one, so we still wear masks until that happens, but we'd wear masks, we would sit in separate family units in our houses. There was a formal and informal dining room table and our kitchen bar, we would segregate out that way and try to do things outside when the weather was nice.\n\nDr. Fisher: But having that support structure of a few people that you could still be engaged with helped, but we really did follow the CDC guidelines on how to do this safely. And all of us have made it through without somebody coming down with COVID. I think I've had scares but the testing came out negative for that. So those were things that helped... And then again, I think my colleagues, it helps that I really enjoy being around the people that I work with. And so they're not only my colleagues, but they're also my friends, we have fun group texts that we engage in that keep things lighthearted and fun. So I think that that's been a way that I've been able to balance everything.\n\nMorgan Weiler: Yeah. What have you both learned maybe about yourself, maybe about something else during this COVID pandemic that you'd like to share?\n\nDr. Fisher: I think one of the things that has really struck me the most is how political this pandemic became instead of just looking at what the science says about things. I use my voice to try to advocate for science, but I just was floored sometimes how people on Facebook or other social media would discount that that was inaccurate or that I was biased towards a certain political view. For me, I look at my physician friends who I know run the gamut, people who are very politically conservative, Republicans, people who are very liberal, progressive Democrats, but when it came to COVID and the best way for us to take care of patients and to protect each other, we didn't disagree on that. And so it was so interesting to see how family and friends would choose sides of this based on political leanings, not really based on the information that we were trying to share. So I think that was probably one of the biggest things to come of this for me.\n\nDr. Rohrberg: I have a couple of things. I would say, number one, nothing is certain. So no matter what we think, it's probably going to change. So lowering your expectations and trying to be flexible is good. And the second thing I think is that sometimes it's really hard to do the right thing and sometimes you just have to do the right thing because that's right. And we cannot control other people. And as much as you would like to, all you can do is do what's right for you and what you know is right for your family and your patients and pray, pray for everyone else.\n\nDr. Fisher: Yeah. I wrote down that I think I've learned that what it is that I need, are those things that really fill my cup and recharge me, and I've been able to let go of people or things that really drain and try to take away joy in my life. So I think that's been a good thing, that's helped give me some clarity on that.\n\nDr. Rohrberg: I think that's so true. I think that seeing how COVID has impacted people, my grandfather died from complications of COVID and it just puts things into perspective to what is really important. And so just trying to keep that in your mind at times is also really helpful and meaningful.\n\nMorgan Weiler: Yeah. There's a couple of rural physicians that deleted social media for reasons that you both are saying, and they haven't even gotten back on, even though things have settled down a little bit, but very interesting. So if we could do the past year over, would there be anything that you would do different?\n\nDr. Fisher: I think I probably would've, I guess, jumped in a little bit more eagerly into the telehealth. I think I dragged my feet a little bit on that, and part of it is technology doesn't always work the best sometimes... Which was nothing that Dr. Rohrberg or I could control, but I do think that I have come a long way with feeling more comfortable with telehealth. And I think that definitely I should've been like, \"Sign me up for some of these visits, I want to learn how to do them. I want to be a resource for the residents, if they run into issues.\" But I watched them more struggle first before I later jumped in.\n\nDr. Rohrberg: I think maybe just knowing hindsight's 2020, I would have, I guess, put a little more focus on mental wellness for myself and my friends. And I don't know exactly what I would've done differently, but maybe just been more aware of the outcomes. I think everyone was waiting for the next thing and waiting for the next thing, instead of at times, looking at the big picture in the long run. I'm trying to think. Maybe I would have watched more Netflix shows.\n\nMorgan Weiler: That's awesome. So what do you think that came out of COVID-19 will be permanent and here to stay? You guys have already mentioned maybe some things in the clinic, some of those cases, but is there anything else that you think is going to be permanent?\n\nDr. Fisher: Yeah, I mean, I think that we're going to... So we talked about telehealth, but I think that the use of Zoom for people who can do more work remotely, I think we'll see more of that. I mean, at times, there's that need for face-to-face personal interaction. And some meetings probably facilitate better if you can have in-person meetings, but I do see that sometimes people may have more flexibility in being able to work from home. When I think about the ability to attend conferences remotely, I think that we'll definitely see probably more blend between people who want to be there and the people who still want to attend a conference, but want to be able to do it remotely.\n\nDr. Fisher: So I think that there will be definitely more of that as well. I wonder if there might not be more mask wearing, especially maybe around respiratory disease times, because it's so interesting that with the mass mandates for COVID, how little influenza we've seen or other respiratory illnesses really, and it just makes you think in the future, might there be more of an awareness in our society that if you are sick, that if you have a cold, to wear a mask, to try to limit being out and about as much. I mean, I think before COVID, yes, I was aware of respiratory illnesses, I got my flu shot, but I still came down with usually a couple of respiratory infections each year. So yeah, I just wonder about our impact with mask wearing.\n\nDr. Rohrberg: Yeah, I agree. I think that I am hoping that our society will slow down a little bit in the sense that realizing we can be productive from working from home or more productive with online meetings or doing things through email instead of trying to always be at the office. And also continuing the modified curriculum.  So allowing kids of all ages and even residents and students, allowing the continuation of a mixture of virtual online and in-person education.\n\nMorgan Weiler: Yeah. So two more questions. Where is your sense of where family medicine is going in the future?\n\nDr. Fisher: I'm really excited about where I see family medicine going because of the students I get to work with, the things that are important to you, addressing social justice issues, addressing health equity, welcoming diversity, being more inclusive, those are all things that excite me about family medicine. I think we are the specialty that's best situated to address health inequities, provide care for those who are in the margins, whether it's safety gaps in urban centers or whether it's rural communities. We have a unique skillset, and I think that there's just so much energy that I sense within our specialty at trying to just make the public, our government, insurance companies, just aware of the value that we bring. So yeah, I think that this push that we have to try to... I can't remember what the numbers are, if it's like 25 by 2030-\n\nMorgan Weiler: Yeah. Number of residency spots and students going into family medicine. I don't remember the number, but it's something really impressive.\n\nDr. Fisher: Yeah. I mean, I think that that is what's needed if we're going to save our healthcare system, it's going to have to be a system that really relies on a strong primary care foundation. And so, I mean, I hope that that means that where we're going is that we're going to have a seat at the table and that we're really going to be able to affect change.\n\nDr. Rohrberg: Yeah. I agree. I agree with all of those, and I don't know that I can say it any better than that, but I am really excited for the continuation of increasing diversity within family medicine. And I'm really excited for the next generation of physicians working to continue that, to improve reimbursement and payment and to reach out to those underserved areas in different ways, learning how to be innovative with providing care while also focusing on maintaining that work-life balance. I think that the next generation of physicians are really going to recognize and fight for the importance of that.\n\nMorgan Weiler: Awesome. So any views on important issues in the specialty related to COVID-19 that we haven't addressed or that you'd like to share.\n\nDr. Fisher: Yeah. The only thing with regards to COVID-19 specifically that I've seen a lot of conversation about, that I think is really important is vaccine accessibility and the fact that family medicine doctors have really been left out of that equation. I just think that think of all the vaccines that my patients were able to get from my clinic, whether it was pediatric or adult and at that time, if I have a patient in front of me and we have that conversation, and if they trust me and they say, \"Okay, I agree I should get this,\" and I have it, right then and there, I can vaccinate this person, whereas it's tough when you say, \"Okay, now here's the steps you need to take. You need to get onto this website, fill out this form, wait until it's your turn to get it.\" I just think that that is an opportunity that we are well situated to distribute the vaccine and unfortunately have been locked out so far.\n\nDr. Rohrberg: Yeah, definitely. And I also think that those receiving the vaccines, the rollout has not been, I think, as streamlined as it could have been. And there are definitely, every state is doing things a little bit differently.  I think about our educators in the community, and I think about our restaurant workers and some of the people that I feel like should have had a faster opportunity to get the vaccine that in some states haven't been, or those with certain health conditions as opposed to just going by age. So I think looking back, I hope that we could have had a better process for getting people vaccinated. \n\nDr. Fisher: Yeah. And the other thing that I think about, initially when the vaccine was rolled out in Kansas, I think our numbers, like we were one of the bottom states as far as how efficiently we were giving it. And some of that, it was also dependent on the processes of how that data is entered, but think about all of our offices are so used to nurses giving vaccines and putting that data into webIZ.   We have a process, we know how to do that well. And again, if there would have been a way to somehow get that, I think that would have made Kansas from the start, probably look better because we've been working in that space as physicians and nurses and medical assistants in clinics. And I think we could have been very efficient at getting it all done.\n\nMorgan Weiler: Yeah. Almost reinvented the wheel in Kansas. Is there anything else that you all would like to add? This has been wonderful, but-\n\nDr. Fisher: The only other thing that when I look back through my notes as we were talking, as I was trying to prepare for this, one thing that I think it's the effects of systemic racism on health in our country. I don't know if everything that happened in the past year, if it would have accelerated our awareness, our understanding, our desire to act as quickly as it all did, if maybe the pandemic hadn't happened. And so I think because of that, I do think that there's really some great work that is being done that will really make a difference. And maybe that is something that we have the pandemic to thank for.\n\nMorgan Weiler: Yeah.\n\nDr. Rohrberg: I can't beat that.\n\nMorgan Weiler: All right. Well, I'm going to pause the recording.","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2334/collection_resources/102721/file/202341#t=0.0,2807.08"}]}]}]}