Diversity, Equity, and Inclusion in Hand Surgery with Michael Galvez

Season 3, Episode 50.  Chuck and Chris welcome Michael Galvez from Valley Childrens Hospital to discuss DE&I in hand surgery.  Michael co-edited, with Kevin Chung, the latest edition of Hand Clinics with a number of outstanding contributions from hand surgeons across the United States.  This volume of Hand Clinics has insights and practical recommendations for all of us considering the challenges and opportunities around diversity, equity, and inclusion.  Three months of free access at:

https://www.hand.theclinics.com/current

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Transcript

Charles Goldfarb: 0:03

Welcome to the upper hand podcast where Chuck and Chris talk Hand Surgery.

Chris Dy: 0:07

We are two hand surgeons at Washington University in St. Louis here to talk about all things hand surgery related from technical to personal.

Charles Goldfarb: 0:15

Please subscribe, wherever you get your podcasts.

Chris Dy: 0:18

And thank you in advance for leaving a review and leaving a rating wherever you get your podcasts.

Charles Goldfarb: 0:23

Oh, hey, Chris.

Chris Dy: 0:25

Hey, Chuck, how are you?

Charles Goldfarb: 0:26

I'm great. How are you?

Chris Dy: 0:28

I'm great. You know, it's an it's an evening and I miraculously helped put the kids to bed and did not fall asleep. Although it was very, very close. It was a post holiday clinic. So it was a crazy one. I'm sure you had one as well.

Charles Goldfarb: 0:43

Yeah, had an interesting day, I had a very busy clinic. And I had to squeeze a couple of surgeries in at the end of the day. Which stressed out my nurse stressed out the whole team, but I love it when it works out.

Chris Dy: 0:56

There was a day a couple of weeks ago, where I squeezed a case in during the lunch break, which was amazing, somehow pulled it off, finish the clinic on time, and if not a little early. When I'm in a conundrum right now, or I'm trying to squeeze a case in before clinic this coming week, and then a case at the end of clinic. It's gonna be a juggling act.

Charles Goldfarb: 1:16

It is super interesting. As we approach the end of the year, every single patient that comes in the knee surgery says can you do this before the end of the year? And I'm like, I would love to and I work really hard to do it. But we couldn't be looking at the end of January or February actually, which is not my usual and I feel badly but I just there's nothing else to do.

Chris Dy: 1:36

Yeah, I think we talked about on a recent episode via the uniqueness of American health care. Put it at that. But yeah, I should have already picked up extra time at the end of this month for this reason. And I'm still jammed up because there's just not leaving enough room for fractures and whatnot. So you know, it's it becomes a stressful December and hopefully a less stressful January. Absolutely.

Charles Goldfarb: 1:59

Maybe a quick shout out to our partners at Practice Link.

Chris Dy: 2:05

Yes. So the upper hand is sponsored by practicelink.com The most widely used physician job search and career advancement resource. Becoming a physician is hard.

Charles Goldfarb: 2:14

Finding the right job doesn't have to be joined practice link for free today at www.practicelink.com. You know, you and I are getting together. We do this in the evening sometimes, but when we have special guests from the West Coast, we you know, we can't do it at 6am

Chris Dy: 2:31

Yeah, we can't and we shouldn't that would just be cruel to them. I feel bad when we have our West Coast colleagues traveled to the east coast for for conferences and meetings and we're making them get up at 3am their time to start meeting so you know what we'll show a little mercy. We've got a special guest today. Dr. Michael Galvez is joining us. And I think Chuck, you wanted to introduce Mike.

Charles Goldfarb: 2:50

I definitely do. I definitely he lives in in the same world that I do, which is super fun. We've shared a couple patients and I'd like to give a little bit about his background, which is super impressive. So Mike is board certified in plastic and reconstructive surgery and he works at Valley Children's Hospital. I believe he began there in 2019. His background is a degree in Molecular and Cellular Biology from Cal Berkeley medical degree from Stanford, and Howard Hughes Medical Institute Research Fellowship followed his residency in plastic and reconstructive surgery was also at Stanford. And then he completed two fellowships, the first enhanced surgery at University of Washington in Seattle, and then a six month fellowship with our friends at the Texas Scottish Rite Hospital. Mary Beth Ezaki, Pete Carter, Scott Oishi and Chris Stutz. So I think I am super happy to get this chance to talk to Mike and he is going to talk about a special I guess, endeavor, that is really how he lives his life, but is coming in print to all of us very soon. Welcome, Michael.

Mike Galvez: 4:07

Thank you so much for having me appreciate it. It really is, it really is an honor.

Chris Dy: 4:12

Before you get into the, into the heart of the episode, I do want to mention a lot of the work that you're doing that isn't on in your formal biosketch. And in your CV, you do a tremendous, an incredible amount of mentoring. You know, I think channeled through social media mainly, but with tons of upper underrepresented groups in medicine. The work that you're doing is fantastic. And I remember pulling you aside and wanting to talk to you a few years ago, one of the hands society meetings, just to know more about your work, but it's incredible what you're doing. And Mike has been a tremendous resource to so many people who have would have no idea how to approach applying to med school, how to approach residences, and not just people going into plastics or hand just people from all over in terms of, you know, aspirations to be a medicine. So Mike, I want to make sure that that works. gets recognized before we jump in. And it does dovetail nicely into what you what you're going to talk about with us today.

Mike Galvez: 5:06

Yeah, thank you so much. It's the you know, the day to day job, as a pediatric cancer surgeon is, you know, amazing, taking care of those patients and with their families and the team that we have here. But the social media aspect, just like you mentioned, the mentorship and doing outreach. I just, I can't get away from that. I just, I really, always go back to that, to try to bring the next student forward if we can.

Charles Goldfarb: 5:36

Yeah, it's, it's, it's really great and certainly is something that, you know, we can all aspire to do more of. So explain how for the listeners who may not and I don't know if it's just on Twitter, or or as far as the social media part of it. But is this Do you have, I guess, students of all varieties reaching out to you, who may not otherwise know your work, just say and kind of asking your questions, or is this kind of just talk to me about how it works?

Mike Galvez: 6:04

Yeah, sure. So it started in the end of my residency, and the beginning of my hand fellowship, and simply I just looked at, it was specifically Instagram, mostly, but I just saw that there was a lot of physicians and surgeons on there. But to be honest, I saw that a lot of them were, you know, modeling the latest handbag or promoting something, you know, to monetize it in some way, or form. And I was just a little bit taken aback because I was, you know, meet students and I would look at social media. And it just, it didn't really make that connection. And this is before the pandemic. But at that point, I realized, you know, physicians, and surgeons are working so hard and what they do with their head down, doing research, doing academic academic pursuits. And sometimes we fail to look up and see the next generation that's coming through and the next generation was on social media. And actually, the world was on social media, right, because we quickly found that out during the pandemic, and the mists, misinformation. And, you know, which is sometimes ongoing. And so I do think there, it's incredibly powerful to stay relevant to where patients are, you know, patients right now, when they come into our clinic, you know, they've watched a tick tock video, right, about what their congenital hand differences, they've seen somebody who's had that congenital hand difference before sometimes, which in the past never would ever happen, you know. And so, yeah, so that was staying in touch with that. And so by showing what I was doing on social media, so sorry, showing what I was doing on social media in real life, and telling my story resonates with students and students will essentially reach out to me. And so I am in the Central Valley in California, where it's a standalone pediatric hospital. And so I don't I don't have, you know, medical students that are interested in surgery that come through, I have undergrads that come through, I have residents at UCSF Fresno that come through. But the way that I've been able to help at least contributed some of these students that don't have a home program from another part of the country, and help them kind of guide them through the process, connect them with mentors, similarly to what's done in an academic institution, where you have a student, you connect them, when they go to someplace else, you connect them. And so it's been really nice to be able to help at least in a small degree, to send out my recommendations for plus, particularly mostly for plastic surgery, to get those students into these really competitive fields.

Charles Goldfarb: 8:50

Yeah, I love it. You know, Chris, and I've talked on the podcast, about the role of mentorship and the way you put it actually makes me feel like I take some of my opportunities to do just that for granted. We, you know, we have a wealth of incredible medical students and residents and fellows and people applying to those roles. And I think I do I've learned to, I guess, value, the impact I can have, we can have, all of us can have, and I'm trying to kind of, as some might say, lean into that a little bit more. I know, Chris, you've done a great job, with mentoring opportunities as well.

Chris Dy: 9:29

And I've done my best I think that many of us have been the beneficiaries of mentors who've been very influential. You know, I had a mentor in medical school who essentially gave me the opportunity to do research with her. And from there, it just kind of took off. So you know, even little things like like Mike was saying seemingly little things to us, like just connecting somebody sending an email making it easier for them to get their foot in the door makes a huge difference to those that are following behind us. And I think it's incredibly smart. You know, for for you Mike to have recognized that You know, we have to meet the next generation where they are and not expect them to come to us. You know, I think one of the things I'd love to hear about is this special edition or special issue of hand clinics that you have co edited. I'd love to learn just kind of a high level what the issue is about, because that's why we wanted to have you on to discuss that, and also how you, you know, earn your way towards that opportunity.

Mike Galvez: 10:25

Yeah, I I'm, you know, incredibly grateful to Dr. Kevin Chung, for allowing me to, to take this on, essentially. And I presented several topics, actually one of them being, you know, pediatric cancer surgery. But the one, you know, that I was particularly interested in, and you could tell by, you could actually tell is looking back at some of my notes about how much I cared about each individual topic within the issue. And I think that likely shot, you know, showed that it showed Dr. Chung, that there was a lot to talk about. And so the, this really, it's less than a year, so back in January of this year, this topic of diversity, equity and inclusion, we started to talk about it as making this into an issue within hand clinics and I, I look at hand clinics, I'm actually really lucky at Texas Scottish Rite when I was there, they had two volumes of everything, like the Journal of Hand Surgery, and Hand Clinics, they had two volumes, one volume was in the main aspect of the Hand Center, the other volume was in the main aspect of the pediatric orthopedic hospital, I got to have that extra copy. And so I have like full copies of the hand clinic sitting up here, and I look at them and I pull them out. And you know, Gilbert wrote a copy on pediatric hand and there's just there when you go through those issues. It they mean a lot to me, because that was that's my reference, right? It's my reference point for some really tough topics. And Dr. Mitch Pet. He was the one that introduced me to Dr. Chung he had just finished editing the an article on avascular necrosis, which is not article started an issue on it. And, you know, it just came out. And it's those articles are amazing. And I know somebody else who's currently using them to figure out a tough problem within Kienbocks looking at that issue, to help figure out that problem. And so that's where the initial idea came about was these discussions with Dr. Chung and coming up with a list of articles. And actually, one of the persons that I really spent a lot of time talking with was with the American Society of surgery, the hand and was specifically our diversity task force was Dr. Megan Conte Mica, right? Getting her insight. And initially coming up with these with this table of content and deciding what are some of these topics that need to be the need, we need to go into on a deeper level, to understand and, and take it to a higher level. And so I know you guys talk about the Harvard Business Review all the time. But that is what I love. I love those articles, how you can pick them up, read it and then apply it. And so that was the approach that we took with this as well as how can we make this very interesting, right? This isn't a diversity, equity and inclusion course that you have to take online and get through it to get a certificate at the end or something you have to check off, you know, be for when you're coming into a hospital. How can we actually make a series of articles that someone can read, enjoy it, and then hand it off to someone else? And that's what we've that's essentially what we've done through these 15 separate articles. And so it's not it's not me, right? This is it, looking at the author list. And all the authors that spent a significant amount of time to make this their specific article come into fruition and come into complete clarity. It's just been it was such a an enjoyable experience in working with Dr. Chung and working with all of the authors to make this a reality. Right.

Charles Goldfarb: 14:28

Well, it's a great introduction. And I have to say, the list of authors you were able to put together and the chapters they have written are really remarkable. I mean, it's sort of a, as I think you mentioned in your introduction, it's sort of a who's who in hand surgery- so many remarkable contributors. Maybe if it's okay, can we perhaps dive a little deeper in your chapter? Or? I mean, so you're you wrote the introduction with Kevin, and then your Chapter is the Underrepresented Minority in Hand surgery Challenges and Strategies for Success. And your co author was Marvin Dingell. So tell us a little without giving away everything. But tell us a little about that article and, and Marvins contribution and just give us a little more there.

Mike Galvez: 15:13

Yeah, so the, the preface was something that, you know, I've, we've discussed before, within the Diversity Committee in the hand society, and something that I frequently present. And it's, it's, and I talk about it all the time, because we talk about it with our patients all the time, right? When we mentioned there's a hand problem right there, like, oh, the bone is broken, right? But it wasn't just the bone that's broken, right? It was the hand versus an ATV, right? It's the tendon, the ligaments, the soft tissue, the skin, the nerves, you know, the blood vessels, the skin. And so all these tissue types, the diversity of the hand is what allows it to function right? That's what that's why this specialty was created. By Dr. Bunnell, right, and the in that same light, we really value the diversity of how we are trained. And you know, somebody who comes in who's trained in orthopedics and knows how to put bone together, you know, for them to go into a plastic surgery type. You may even be with an orthopedic, something that a fellowship fellowship that focuses on microsurgery that frankly, focuses on nerves, that's going to make them a better hand surgeon, they're going to be more complete, they're going to be more comfortable. And guess what, they're going to be better at taking call or taking care of patients wherever they end up practicing, right? So that your blessing when you train somebody, and you train them completely, as a hand surgeon comfortable in all these aspects, you are making a hand surgeon that's comfortable from the fingertip to the shoulder, they're going to land somewhere in the United States, and they're going to be an incredible hand surgeon for their patients. And so if we value that we value these things, as a hand surgeon, we value the anatomy, we value the training. And so that's that's what the preface is talking about, as we add in that same light, who we train also becomes important and that diversity of people, whether it's female, whether it's an underrepresented minority or someone for with an LGBTQ background, it's anybody who comes through is going to make our specialty stronger. And so we're seeing we've seen those changes, particularly in the last 20 years. But something has changed, there's been essentially things have come to a standstill as far as the percentage of the underrepresented minority. And so what does that mean? It's defined by the WMC is Native American, Pacific Islander, Latino, or Hispanic, and then Black or African American. And so when we look at those numbers, when we look at the data, the percentage that are represented in orthopedics in plastic surgery, in general surgery, and especially in hand surgery, are incredibly low. And that's what the article talks about is Dr. Marvin Dingell is awesome. He's from the military, Walter Reed, he's currently doing his fellowship and ortho Carolina is going to be incredibly trained, right. And he's going to go back to Walter Reed from what I heard back into the military, and he's going to be an incredible hand surgeon. And so what we did was put together an article of rather than focusing on, you know, the secret of hand surgery, you know, this is the secret field, you know, that, that nobody else that people may not know a whole lot about, and is a little bit mysterious, and laid out in a way that I can literally send this, you know, send this article, give this article, hand this article, to an underrepresented, undergraduate student, medical student, resident, fellow, and even an attending and they can read it and understand what it what it takes to get there, and some of the challenges that they can anticipate. Because it's not easy, right? It's you have to get into one of the most competitive sub specialties, orthopedics or plastic surgery being the most common, and then you have to reapply into hand surgery which as a fellowship, you know, that's very competitive, especially if you're coming from orthopedics and plastic surgery the same it's you have to interview at many places go through the match process to get into a very special field. And so how do you do this? You have to have a meticulous approach that involves mentorship that involves ensuring that your somebody's telling you right you have to do well on your inservice on your your your You're in service training exams, you have to do well on your, you have to get letters of recommendation, things that you think are standard, right, and I'm sure standard at the top fellowships, but sometimes with one of the things, one of those things gets lost or doesn't get checked off, that person can fall off, essentially, and lose that opportunity to help and help our field join our field and really make it as strong as it can be. And then Dr. Dingell even introduced the part you know, section called The Life interrupted, you know, what if you have someone who is African American, for example, and something happens across the country, you see it through the media, and it's, it's, it's violence or something, and that could specifically affect that resident, right? That fellow, that attending to a point where it may not always be seen and understood. And so even as a fellow or as an attending, reading on this, it's almost like, I wish I had this, I wish I had this type of guidance from from, from someone that understood my perspective as I went through this really hard process to become an excellent surgeon. So that's, that's that one in a in a nutshell. And so it just goes into specific details on how how to get into this into this specialty. And what's cool too, is it doesn't anybody can read this article, right? That's what's awesome about this, too, is we want it so others can understand. And any of this can be handed to anybody, and they'll understand the how to get into our special field.

Chris Dy: 21:47

What I love about what you just said is that you know it, it takes some of the mystique off of a lot of these concepts. For those people that are familiar with it and have lived it, but have not found a way to identify with others and share that experience that gives them kind of the Hey, it's okay, like, this is what people go through. And I've never really thought about it or talked about it. But now I know that I can bring this up or at least share this article with somebody so they can understand where I'm coming from. And then you know, what I loved about the table of contents is that you cover a ton of topics that are accessible from various points, you know, whether you're, for example, say you're a white male hand surgeon, and you kind of understand some of this stuff, but it's a little bit intimidating to try to step out of your comfort zone. Um, you introduced the concept of ally ship, which I think is hugely important and even, you know, more general than ally ship, but kind of the sponsorship and mentorship that we talked about in our professional circles all the time agnostic of whether somebody is underrepresented or not, but maybe talking about the value of that, and how much more important it is perhaps the somebody who doesn't have all the opportunities that, you know, that we feel like Chuck said, we take for granted, you know, what we're able to take advantage of ourselves, and, and, you know, make up make available to our trainees in our immediate network. So I think it's fantastic. I mean, one thing I would ask you just purely from an editor perspective, is that this seems to be and rightfully so a bit of a passion project for you. How do you allow others to write this? Because I bet you probably could have written every single article in this. And it's hard because I know that sometimes people feel so strongly about it, it's really hard to let your baby go and see somebody else write it perhaps in a different way, maybe just as good or even better than you would have written it, but not exactly how you would have encapsulated it. So how did you? How do you

Mike Galvez: 23:35

That was the fun part. Actually, I really enjoyed navigate that? the fact that it didn't have to write all these articles. Just kidding. I really enjoyed that. I got to I had the opportunity to think come up with this, the table of contents, and come up with what ideas and topics need to be covered. And then figure out who would be the best person to take on this topic. Not only that, but hopefully they have the bandwidth right to take it across the finish line, right? Because these are not these are topics all of these articles are articles that have never been written about. They've never been written about. And that was the part where I knew we were onto something because I pulled it before we even started writing the articles I I pulled 255 articles, references from orthopedics, plastic surgery, and general surgery. That was my general literature review to include all of these articles and just suggestions for the articles for sorry for the authors. And so yeah, you're totally right. I think could I have taken on each article I could have but I was you know, thinking of like, like Dr. Moore for example, right. She is the chief at Ohio State like I was honored you know that she accepted to take gone this really challenging article on on talking about the diverse leadership and answered you know, Dr. Flatt was in I think it was the second immigrant to be the president of the American Society for Surgery of the Hand I, I think I'm confusing them between the first and the second, but he, you know, when I found that out, like I'm like, we're on to something talking about these topics, and talking about them to include women, minorities. And, and something that we may have already something that you take, you know, you just, you don't even considered like, for me, I came from Stanford, right, where Jim Chang was my boss as a medical student, right. I and one of my mentors, and watching him and him training me through my through medical school, and, and residency, and then I was finishing residency, he was going to become the president of the hand society. And I was like, That's amazing, you know, and he's definitely, like, it just for me, it just makes sense. Like, of course, he's going to be the president of the hand society. You know, he worked so hard and mentor, so many, and this is has been focused on the hand society for so long that he's only in to my knowledge, and from what I can tell, he's the only the second Asian American president for the hands society. Right? That's, that's something that we don't even don't even think about until, until right until seeing some of these topics come into fruition. And, and the impact that many of these leaders have made, and I love how, you know, every, every author made their contribution as far as keeping it very relevant, right? We're not just talking about leadership as far as Oh, it you have to be what what defines success, right? You have to become a leader within the hand society or ahs? No, there's different types of levels of success from the position that you're in innovation or an academic perspective, there's so many ways and that what's awesome is some of several of these articles, did help define that and show that there are many ways to become a successful hand surgeon. And so as you know, there's 15 separate articles. So I literally can talk about each one for an hour, and talk about how the process came, came to life, but every single author, then just another example would be Dr. Wendy Chen. She is a plastic surgeon, she practices in Houston, and a hand surgeon trained at UCLA. She has a group she's created called times up PRs related to plastic surgery, and creating general awareness to and so she took on the women in hand surgery, leadership and legacy and she conducted like, I want to say like 100 interviews of different women within hand surgery, her and Aileen Topaz. And just to get, you know, to get a, like synthesizing all those interviews into one article into the first article that's ever been written about the women enhance surgery, leadership and legacy. That's a lot of pressure. I'm not gonna lie, that's a lot of pressure. That's, you know, you're profiling. Dr. Marybeth Ezaki, right, she's looking at your articles, they and they had everybody, you know, sign off on their article into a level of detail. And it's just it really is incredible the amount of work that each specific author did, and I literally could I can talk about each one in a lot of details, but I'll refrain because I think I'll take up an hour or more.

Charles Goldfarb: 28:49

Well, I know we could talk for a long time and passionately about it is super interesting. Because if I get asked to write a chapter on you know, we talked about ABM illuminate, you know, I can create a little internal excitement about writing about ABM illuminate, but it's just a little bit but it is obviously you've hit on something important to many people. And the passion that was brought to the table for these chapters is evident. Your own passion, as you've so nicely shared with us tonight, but in the writing of others, and just to before Chris kind of wraps things up, I don't know that we ever formally stated this is the February 2023 Hand clinics. And the title of the of the book is diversity, equity and inclusion in hand surgery and it is edited by Mike Galvez and Kevin Chung and and for those of you who don't have access to it, find access because it's remarkably good. Chris and I are lucky enough to have access. And I'll turn it over to Chris to make a few final points before we wrap this

Chris Dy: 29:59

So congratulations to you. And Kevin, Mike on a up. fantastic addition, I look forward to trying to get my hands on the paper copy at the at the library, but definitely reading it online, we'll make sure to link it in the show notes. You sent us a particular article that one of our friends of the podcasts and a personal friend Micah Sinclair wrote with Micah wrote this with me check, double check, I want to make sure I got a credit. Dr. Chabbra, over at UVA. Man, it's great because it talks about issues of retention of, you know, diverse, diverse faculty and kind of what the implications of, you know, if you don't have a diverse faculty, you're gonna have a hard time recruiting diverse trainees and how you can make sure that, that that stays an important piece of building a department and leadership. So tons of stuff in here, really accessible at every level. So congrats on that, you know, I think that you're doing some amazing work. And looking forward to seeing maybe in 10 years, you can give us another hand clinics with an update on the progress, you can convince whoever's the editor in chief at that point to to give you another shot at it.

Mike Galvez: 31:06

Thank you. Yeah, yeah, that I appreciate it. Yeah, I can, I can rave about that article as well for a long time. But that's that was exactly right. It's you have someone who's built a department at the University of Virginia and, and, you know, the thought process behind it and the ways to be successful and having these actionable items, that, you know, it can become irrelevant. And so that's why I really encourage and I'm hopeful, you know, that many, and it's actually open access for the next three months. And it was great that El salvia agreed to allow it to be open access. But I'm hopeful you know that residents, fellows attendings will end up doing exactly what the dream was, which is coming up with something that is interesting. That is important. That is for our patients, and that we can hand to each other right hand to each other and say, You got to check this out. This is a way that I've made some improvements in mentorship and recruiting and understanding how to be an ally in understanding how to reduce microaggressions and implicit bias, etc. So I really appreciate you guys. I really appreciate your time.

Chris Dy: 32:24

Yeah, Mike? Well, you know, you've the fact you said is open access is all of our international listeners ears perked up, because I know that it's sometimes hard to get access to American journals. And while there's clearly an American perspective and bias in in how these topics were written, I know they're probably very relevant and salient to listeners all over the world. So Mike,

Mike Galvez: 32:43

there's there's an article there's an article on the international medical graduate perspective and surgery with profiles, not just those that have contributed like Dr. Neil for Jones, Dr. Linda Cinderella's, who was she was the first Latina hand surgeon I'd met. But also talks about the challenges like the realities. And that's what I think that's what we need. And hopefully, hopefully, it'll be taken in.

Chris Dy: 33:09

So we'll make sure to put the the link to the Open Access download in the show notes. You heard it here. First, you get it for three months, so make sure to get to your computers and download that. Mike, thanks for joining us, and we look forward to many successes for this issue.

Charles Goldfarb: 33:23

Mike, thank you so much. Yeah, Mike, thank you so much. Fantastic talking to you. And congratulations. Again, really remarkable work. And I have dived in a little bit, and I look forward to diving in more. So thank you.

Chris Dy: 33:41

Sounds good. Well, be sure to check us out on Twitter@handpodcast. Hey, Chuck, what's your Twitter handle?

Charles Goldfarb: 33:46

Mine is@congenitalhand. What about you?

Chris Dy: 33:49

Mine is @chrisdymd, spelled d-y. And if you'd like to email us, you can reach us at handpodcast@gmail.com.

Charles Goldfarb: 33:57

And remember, please subscribe wherever you get your podcast

Chris Dy: 34:00

and be sure to leave a review that helps us get the word out.

Charles Goldfarb: 34:03

Special thanks to Peter Martin for the amazing music. And remember, keep the upper hand. Come back next time