Introduction
Our second episode highlights Dr. Joseph Margolick, a general and trauma surgeon as well as Assistant Professor within the Division of Trauma and Surgical Critical Care in the Department of Surgery. In this podcast, we cover topics related to his career pathway and his interests, including research, global health, differences between healthcare systems, etc. Listen to learn about his passions both inside and outside the hospital!
Information about the article mentioned regarding the six pillars that indicate sustainability of global surgery partnerships:
Jedrzejko N, Margolick J, Nguyen JH, Ding M, Kisa P, Ball-Banting E, Hameed M, Joos E. A systematic review of global surgery partnerships and a proposed framework for sustainability. Can J Surg. 2021 Apr 28;64(3):E280-E288. doi: 10.1503/cjs.010719. PMID: 33908733; PMCID: PMC8327986.
Episode Transcript
Hannah: Welcome to the second episode of mentor spotlight, a podcast designed to help connect UAMS medical students to faculty mentors. We are Hannah, Manasa and Weijia, your host for this episode. Today we have Dr. Margolick, a general and trauma surgeon as well as a surgical critical care specialist in the surgery department at UAMS and he is excited to be a mentor for students.
Manasa: Dr. Margolick is originally from Canada, he first moved to Texas where he completed his fellowship in trauma and critical care surgery then he came to Arkansas. His past experiences include working with the Canadian Red Cross global emergency response unit as well as working as a research assistant and Tel Aviv Israel. He has done research on numerous topics from trauma care to global surgery initiatives he has helped to develop institutional guidelines within UAMS here.
Weijia: If you ever work with him during rotations you will see that he is very passionate about teaching students and is an advocate for student involvement. He is the epitome of Canadian kindness we can not wait for you to meet him so without further ado let’s get started! Alright Mr. Margolick…
Everyone: *laughing*
Dr. Margolick: That’s alright, yeah it’s MarGoLick, yeah and it’s just it’s kilogram backwards if you ever forget.
Weijia: kilogram
Dr. Margolick: Yeah, not that it makes it that much easier to remember.
Weijia: OK OK hi Dr. Margolick
Dr. Margolick: Hi
Weijia: Can we start off with you telling us a little bit about yourself?
Dr. Margolick: Yeah sure so first of all I think this is a great podcast and I really commend you all on this initiative. It’s great to see medical students taking interest in mentorship and helping other medical students find mentors so… so good on you all. Yeah so as you mentioned, I’m from Canada. I was born and raised in Vancouver BC. I did my undergrad near Toronto and I did my med school near Toronto and took a couple years off kind of in between. and you know I… I came down to… to Dallas to do a residency or sorry fellowship in trauma and… and actually haven’t been back to Canada since, which is odd. It’s been like almost three years since I’ve stepped foot on Canadian soil and you know I… I really like it here and my passions are really just trauma care, critical care, emergency surgery and just making sick and dying people people better.
Hannah: Nice, alrightly, so for us and M1s who’re new to everything, could you just tell us a little bit about what your job entails, what you do kind of on a daily basis.
Dr. Margolick: Absolutely! I mean I… I really… one of the things I love about working here is that my… my job is quite varied. You know I…I mainly do clinical work and that’s divided between trauma surgery so take trauma call, an emergency general surgery, and those are both pretty full on and then I also do surgical critical care, so that usually is like a week or so of critical care every six weeks and then on top of that I have a you know a modest elective practice that I try to squeeze in and I do endoscopies, colonoscopies, and EGD and then when I’m not you know doing clinical things I… I try to get some research done, so I’ve got a few projects on the go with medical students like yourselves and I’m interested in divisional initiatives like trauma guidelines and then we’ve recently started doing trauma simulations, which has been a lot of fun. We’ve partnered up with the metropolitan EMS service and they had these really cool mannequins that are that are like these, I think they’re called, trauma FX mannequins and they’re extremely lifelike and you can pump them up full of blood and create pulsatile bleeding and have them mimic lots of trauma physiology like tension pneumothorax or airway emergencies, so just like a airliner might simulate various cockpit emergencies we’ve been simulating trauma situations with the residents, so that’s been that’s been a lot of fun. So yeah every day is different and… and then on top of all that you know teaching medical students and residents.
Manasa: It’s really cool you get a wide variety of like differences in day-to-day I guess too.
Dr. Margolick: Yeah absolutely and I mean for someone like me I knew that that was going to be important and that’s one of the reasons why I like trauma. You know we get to operate in different body cavities. You never really know what to expect when one is coming through the door.
Manasa: So we know a little bit about where you trained for medical education, but can you tell us a little bit more about your background in education as far as the undergrad or like even what you wanted to do when you were growing up versus how that changed with time.
Dr. Margolick: Oh yeah, well you know I… I don’t have a formal background in education, you know I haven’t actually done any university training. I don’t have a masters in education or anything like that. I… I got my undergrad degree in… in psychology and biology and I originally wanted to be a clinical psychologist and I actually was gearing up to do a Ph.D. program in psychology, but I don’t know. You know sometimes you don’t even necessarily make decisions or make plans things just kind of happen and I kind of just had a change of heart and a bit of an awakening that I thought medicine was gonna be the right career choice and so kind of near the end of my fourth year of university or sorry college, I pivoted to to medicine and haven’t looked back since. As far as my educational interest, I guess I don’t really have any formal training I think a lot of it is, at least in my opinion, kind of intuitive and a lot of it is based on trying to emulate what my mentors and what my educators helped me with and how they were most effective. So that’s sort of what I try to do. I… I would say that I don’t have any, like I said, formal background or… or formulaic approach to… to teaching or education. It’s just sort of you know what interests me and hopefully my passion kind of seeps through.
Weijia: I see and you said that you changed your interest in undergrad. I was wondering what made you change your interest, made you become interested in *implied trauma surgery and critical care*
Dr. Margolick: You know there was really no defining, I would say no defining moment. It was just sort of a set of various circumstances and you know when you go into something, you know with a preconceived idea of what you think is going to be the end result, it can sometimes take a long time to… to change directions. It’s kind of like turning a big ship and so I think there was just a bunch of different experiences and… and circumstances that just caused me to… to change my mind you know. I realize that I didn’t want, you know, for one thing I wanted to be active. You know psychology is really interesting but I kind of thought I might be a bit bored sitting, you know in an office all day or I just kind of wanted to explore other options and so it’s… it’s really hard to say. There was no defining moment.
Hannah: Was there any defining moment for like, this is I want to do, surgery, trauma surgery, critical care? Or was it like the same, I kinda just ended up here?
Dr. Margolick: Yeah, I mean I’ve never been one to really make a whole lot of plans. You know, I’m not a 20, I’m not someone who, *pager beep* scuse me, I’m not someone who thinks you know twenty steps ahead you know. But it is funny because, you know, psychology is… is very different than trauma surgery. But I think there are some kind of parallels, you know, there’s a real exploratory element of both fields and… and as soon as I started general surgery residency, I just knew that that trauma was gonna be it was gonna be where I… I ended up and… and… and as a Med student I knew that general surgery was where I wanted to be, to end up and I mean I… I enjoyed being in the operating room but I just, I enjoyed the idea of being able to be that doctor that could identify a problem and then fix it. You know I didn’t like handing things off necessarily, and so yeah. It’s funny because as soon as I entered Med school, I mean within like two months, I was like yeah I wanna be a general surgeon and then as soon as I, *pager beep* excuse me and as soon as I started general surgery resident, I was like yeah trauma emergency general surgery that that’s the field for me and I think it just has a lot to do with my with my personality and just yeah I… I like kind of like the unknown and the excitement of not knowing what you’re going to find.
Hannah: Something new everyday.
Dr. Margolick: Yeah!
Manasa: So I guess along with that, do you have, I know we kind of talked a little bit about your research interests but a little bit more about your passions within the field like any specific things that you haven’t already mentioned and I know you mentioned that you do trauma guidelines and trauma simulations and anything else that students could potentially get involved with working with you with or anything like that.
Dr. Margolick: Oh yeah, absolutely! I mean I have quite a few research projects on the go. You know at the research is hard because as a Med student, you know, which you don’t have a lot of is time and you also don’t have a lot of money and research requires a lot of time for no money. So you know it’s tough but it you know I would say that I am really interested in getting Med students involved in… in research not because I feel like I’m the greatest mentor for… for research I’m… I’m not the world’s greatest researcher, but I do think that it is important to be invested in in the future of ones field and it and it just shows a commitment to growth and… and learning within the field of medicine and so I… I think getting involved in research for medical students is… is a really good investment in… in one future and it’s also just something too that, you know, you get to know people and department or the division of the field that you’re interested in. You know for example just like the three… three of you I mean, you know, I know that you’re interested in surgery *indicating Manasa*. I’m not sure about you all yet. If you’re still deciding but now you know me and you know now you’re getting to my other colleagues like that kind of stuff is important for building connections in the future so yeah I think just getting getting those students involved in research I think is… is a good interest.
Weijia: And is there, what are your passions outside of medicine?
Manasa: We are taking a big shift. Yeah like you’re inside the outside *the hospital*
Hannah: Like a complete 180
Dr. Margolick: I think that’s about tapped out on research stuff but you know I… I would say probably like a lot of you have a lot of interest and some of some of them had to take a backseat to training you know. So you know I used to do a lot of hiking. I used to work as a hiking guide and used to run quite a bit. My… my wife, whenever I got too chunky would just sign me up for marathons and I’d participate.
Hannah: That’s something I think my mother would do.
Everyone: *laughing*
Dr. Margolick: Yeah… yeah like you gotta be kidding me. But you know I just like being outside you know fishing or hiking is probably my favorite thing to do now but I haven’t… I have a baby at home and so she’s been taking up just about every ounce of my free time.
Hannah: As kids do. So I know you said that you don’t really plan 20 steps ahead, but are you… do you have any current goals that you’re working towards in the future whether they be long term, short term, inside medicine, outside medicine?
Dr. Margolick: Yeah, you know I… I think at this point you know I’m… I’m still early in my career as a faculty so my short term goal is just continue to progress and continue to get better continue to improve as a surgeon as a clinician and as an educator and there’s really just no substitute for… for experience you know and so that… that’s sort of my… my short term objective is just to kind of come in as someone who’s open to new experiences and willing to take on new tasks to help the department, help the division and… and help myself grow, just kind of like how you are all doing that today. You know my long term goals, you know, I… I… I love UAMS. I think this is such a great institution. I think you know I… I never planned to be in Arkansas, you know but I came here and I immediately fell in love with this place and I think that we have a phenomenal department and a phenomenal division and so, you know my long term goal’s just help continue to grow and develop this department and… and… and turn it into and well continue to… to help it grow and really turn into one of the premier trauma centers in… in the country, which I think it is.
Manasa: So I guess this is more of like your ideals of goals of what you see in healthcare but like what changes would you wanna see in healthcare and what are the main concerns you have with it right now?
Dr. Margolick: Well…
Hannah: A complex question…
Dr. Margolick: Yeah, well you know, I tried a different train a different system as you know the Canadian system is you know universal health care so you know physician and hospital services are… are completely free for… for residents and citizens and so yeah that’s what I was used to you know so dealing with insurance issues and having you know patients without insurance not be able to pay for their services and you know that… that part to me took some getting used to. I don’t have to deal with that stuff on the day-to-day basis but occasionally you know we have to cross paths with the insurance companies and you know it… it… it does sort of bother me that… that access to Healthcare is a challenge for… for millions of people in this country and so I don’t know what the right answer is. You know there were there are downsides of you know universal healthcare system. I mean are… my wait time for a lap Kohli is maybe three weeks you know whereas in Canada might be six months so there is upside to… to certainly to this system I think one of the challenges I’ve seen coming to Arkansas though is that patients come in and they’re not healthy you know.. they don’t see primary care physicians necessarily very often they have untreated disease you know untreated cardiac disease and… and that impacts only my practice but you know any surgeon that comes into contact these patients will have to optimize them and so that becomes that becomes a real challenge so I guess if I could make one change it would be just better access to primary care. You know I think family doctors have such a critical role to play in patients lives and in their overall well-being and long term health so I would love to see patients engage with their family doctors more and be able to access them or more easily.
Weijia: that would be a good change for sure. You said that you’ve worked in the Canadian system too and I was just curious would you recommend students to maybe go out of the country for some medical experience?
Dr. Margolick: I think that’s beneficial yeah I… I mean I… I think so it… it… it… I mean I went to you know if you’re… if someone kind of like you know there’s… there is an adventure element to it you know I… and I think that that’s important to recognize. You know I… I don’t think that two week rotation in another country is gonna, you know you’ll learn some things but it’s not gonna make a huge difference in your medical knowledge. I don’t think, I mean it kind of depends on where you go at least that was my experience so I… I mean I went to Haiti as a Med student and I just I… I met this doctor who was an anesthesiologist at my Med school who was from Haiti and I just chatting with him one day I said you know I really like to go and he was really cool and he just hooked me up with this doc in rural Haiti you know and I just kind of went there on my own for a month and… it was really cool yeah few hiccups you know like I knew it wasn’t a particularly safe country there was a lot of kidnappings at the time and they actually forgot to pick me up at the airport which was you know.. where you are.. scary and you know I learned a lot on that rotation mainly about just healthcare disparities and how difficult it is for you know people to get the care that they need and a lot of other countries but…so from that perspective it was really beneficial and it also kind of plugged me in with a bit of the global health scene which I continue to sort of be involved into this day. So, yeah, think it’s a very I think …I think… it’s exciting and a useful opportunity if one goes into it with the knowledge that you know.. you know maybe the medical knowledge is not the prime objective is to make connections learn about another country, learn about another culture, and… and with the idea that you know it’s best also to to take something away that’s going to be a bit of a…a long term collaboration or.. or commitment with…with…with people from other. *pager beeps* I’m so sorry.
Manasa: so for our listeners that don’t know much about global surgery since we’re on this topic now. I know coming in I didn’t know much about it but I was curious so I guess for a student that’s wanting to know more about it what are some resources or where some places or people that can talk to you about just getting like their toes dipped into the sea of it.
Dr. Margolick: yeah yeah absolutely so a lot of universities are big into the global surgery field so for example, Duke University, UCLA they have large branches and divisions dedicated to global surgery. It…it is a bit of a convoluted field because there are you know NGOs involved there are you know academic institutions there are faith-based institutions all sorts of different fields and specialties so I’ll tell you it is I think it is a difficult thing to…to even start to wrap one’s head around you know because it can just be kind of… all this overwhelming. You know, Operation Smile, Doctors Without Borders, various universities…it’s difficult I think the best way to start is to make a personal connection you know with someone who is actively engaged in the field of global surgery. So for example, here at UAMS Dr Lori is… he’s a colorectal surgeon and really great guy and he’s involved in actually doing trips to abroad. I think he goes to Liberia every few months or so and other various other trips as well that other various surgeons have taken. I personally started out through the Canadian Red Cross and my… it was just just like that was personal just like my trip to Haiti was a personal connection as a trauma surgeon at my Vancouver General Hospital who did some work for the Red Cross and I… you know… we… we were you know friends basically and so she got me involved in the Canadian Red Cross and I was able to go down to Mexico City for a month and just do a trauma rotation there. And that was really interesting because I just went down there to just to get you know to…to learn a lot about trauma surgery. Mexico City is only one trauma hospital in like a city of like 30 million people and so they don’t have a trauma system necessarily like we have here but… And I got to be at it which was really eye opening and very cool and then my last week that we actually had a 7.5 Richter scale earthquake that was you know… tumble a whole bunch of buildings and sadly hundreds of people lost their lives and thousands more injured but… I was just happened to be you know moment zero at Ground Zero of the Red Cross hospital in the middle of Mexico City when this happened so that was so that was quite a wild experience and amazing learning opportunity. So I digress though. I think just developing personal connections is the best way to do it. The field of global surgery has changed so much to where really people are focusing on professional relationship development and sustainable collaboration over many years and that’s changed from a traditional mission style trip where a group of surgeons from you know let’s say United States or Canada or Australia parachutes into a country, operates for two weeks, and then you know leaves. That still happens and…and that’s fine but really the the focus has changed you know there are you know several pillars of sustainability: ongoing funding, bilateral collaboration research, and authorship, ongoing training, and ongoing discourse and you know bilateral binational exchange of ideas and…and that I think is the most important thing for global surgery these days.
Manasa: So Doctor Margolick actually wrote a paper about these pillars as well so y’all can check that out.
Dr. Margolick: Yeah that was my shameless plug. The Margolick Pillars.
Hannah: I know you briefly mentioned the being in the Red Cross. Mexico. Ground Zero. And you had a very unique learning opportunity there. So while it wouldn’t be, I think, coolest would be the best word to describe that experience. What is the coolest surgery that you have gotten to see or do in your experience as a physician?
Dr. Margolick: oh boy!
Hannah: Or some unique cases you have seen?
Dr. Margolick: well well I’ll tell you what a case from yesterday. How about that?
Hannah: The recency effect.
Dr. Margolick: What was that?
Hannah: The recency effect.
Dr. Margolick: Yeah… so… a young guy was shot. Cruiser. Just happened to be cruising by. And somebody flagged down this cop and deputy just loaded this guy into the back of a cruiser and just dropped him off at UAMS ER and which was… that move saved his life which is I think is very cool in and of itself. You know had that deputy maybe stay called an ambulance then you know waited 10 minutes for the ambulance or five minutes for the ambulance and then like he was just wouldn’t have survived. So that…that decision to just load him up in the back of the truck and drive him to the UAMS was that in of itself is a cool…cool feature of the story. So yeah this gentleman showed up with the blood pressure in the 60s. Obviously bleeding from a gunshot wound and I took him immediately up to the operating room where he had bullet had gone from his abdominal wall through the left lobe of his liver and shattered that lobe. It had gone through and through his stomach, nailed his spleen, bounced off of something else, nailed the mesentery of his colon, and then went through his kidney. So yeah that was a situation where there’s almost an overwhelming number of priorities. I mean this guy is bleeding to death from numerous locations and time is really critical in these patients. The longer you operate on them, the more hypothermic, they more coagulopathic, the more acidemic. They get a lethal triad. So once i get into this state, this physiologic state of dying, they just start to circle the drain, so you really need to mobilize quickly and get all this bleeding under control. So I actually, I called my colleague Dr. Matt Roberts, who…another trauma surgeon here. So we work on him together and took out you know a lot of this left lobe of his liver, spleen, kidney, left colon, the left kidney, half of his stomach to get the bleeding under control. So yeah that was my late afternoon yesterday.
Hannah: Sounds like a busy afternoon…
Weijia: just a typical day… for sure
Weijia: So you’ve had a lot of you know international experience and you know you’ve been to Canada you’ve been to Texas. Now you’re here what’s one piece of advice that you give to medical students in general?
Dr. Margolick: One piece of advice?
Weijia: Mhm.
Dr. Margolick: That’s a tough question. You know I think um what’s really important to recognize. You all have decided to become doctors. You could have taken the easy, an easier path in life but you decided to to push yourselves, challenge yourselves, and go into a field that is really important and really challenging and I think that’s really commendable you know. Med school is hard. Residency is very hard. Being a faculty is hard. And so, but the more that you invest in your future, the more that you invest in your career, the more that you invest in your education, the better it’ll be for everybody. And most importantly, the better it will be for your patient. So I would say, you don’t, you only get one Med school. You don’t get redo’s. You don’t get to do it twice. You get one. You have four years to become as good of a doctor as you possibly can be, and so I would say take advantage of every opportunity you can you know. Read 5 pages of a textbook every night you know. Try and do some research if you can. Review anatomy regularly. Get to know faculty. Do things like just as you all are doing. I mean this is a perfect example of…of the kind of things that I would advise medical students to do you know. Create your own opportunities you know. Medical school is not spoon fed to you. You have to seek out those opportunities and take advantage as much as possible because ultimately we have a contract. It’s an unwritten contract with society that you get these enormous privileges of being a doctor and prescribing medications or even doing surgery on patients but in exchange, you have a duty to be as good of a doctor as you possibly can be. So..so keep that focus in mind. Enjoy the moments of training and because if…if you’re constantly looking at the next step you know you’re not happy in university ’cause you’re too focused about getting into med school, you’re not happy in med school cause all you wanna do is get into residency. You’re not happy in residency ’cause all you care about is a prestigious fellowship and so on and it’s like, you know, it doesn’t end you know. Then there’s divisional promotions and department heads and all that kind of stuff to get to ultimately where you’re just in the retirement home of your choice. So it is important to enjoy the moment but also stay focused on the momentous task at hand.
Hannah: On the flip side, what was the best advice you were given? Both either as a med student or just in life in general. You have some if you’re given some very sage words.
Dr. Margolick: Oh man. I’ve had a lot of great mentors and I think I…I mean I’m kind of regurgitating that advice like what I just told you is advice that I got from mentor I really trusted and…and… and he’s a great guy. He’s a trauma surgeon in Vancouver. But you know he…he basically told me you know to be the best surgeon as possible you have to kind of pick the more challenging things. You have to seek out opportunities and challenge yourselves whenever you can you know. The easy…the easier path is… won’t make you better. If you’re always comfortable, you’re not learning and…and that’s true in surgery you know. If…if you’re a resident doing an operation and you’re too comfortable, you’re not…not really learning. You’re not pushing yourself.
Weijia: So what’s trauma residency like? You know we always hear surgery super busy, you don’t get to have a life. How…how much of that is true?
Dr. Margolick: You mean general surgery residency?
Weijia: Even trauma, yeah.
Dr. Margolick: Well the trauma fellowship is…is quite different. You know, it’s… it’s one year, it’s a lot of critical care. It really depends on where you do your…your…your fellowship and so I think there’s probably not a big ubiquitous lifestyle associated with trauma fellowship. It’s busy. You know and just like what’s true for residency, you need to apply yourself every moment of every day when you’re in the hospital. Yeah, I did general surgery residency and I mean I did in Canada. It’s…it’s different you know. We don’t have the 80 hour work. We shouldn’t have to log hours. It was different. I..I think it is a little bit more old school you know. It’s…it’s tough I mean it is you know. There’s…there’s going to be sacrifices. But there’s like most like everything in the human body there’s gotta be some hemostasis or homeostasis where there’s no substitute for experience. You have to recognize that. But you also if you burnout, you’re not gonna be a very effective physician, wife, mother, son, whatever. So you gotta try and find some balance and way to enjoy yourself outside of medicine. But yes, no, residency is busy and it’s hard and you should go into that knowing that it’s going to be hard. In fact, that should be a motivating factor you know. If you’re gonna be a surgeon you have to I think enjoy pushing yourselves and enjoy challenging yourselves and…and…and really feel like you want to rise to that occasion because if you’re constantly…if you’re constantly thinking of the you know the pillow or wanting to take a nap, it’s just gonna make everything so much more challenging. If you’re gonna do a night of call as a resident, if you accept the fact that you’re just gonna be up all night working all night then you know if you do get an hour or two of sleep, that’s a bonus you know. If you go into it thinking “Oh my gosh I just want to sleep!” and it’s just going to be so painful. So you have to go into it with that mindset. So yeah, I…I would say that there’s…there’s no it’s a very busy and challenging five years but the challenges are offset by the thrill of learning to do something that’s so unique. I mean there aren’t a lot of people on this planet who know how to do a surgery you know and…and as you progress in residency, you start to develop more knowledge, more…more skills, more and more confidence, and so that is really exciting.
Weijia: Mindset and passion.
Dr. Margolick: yeah!
Weijia: ..and success.
Dr. Margolick: Yes, exactly! That…that’ll keep you going.
Manasa: Well if a student is interested in working with you, either shadowing you or having you as a mentor, has… just has a question they want to reach out to you about, how can they contact you?
Dr. Margolick: Yes! Email me. Yeah, no problem. I’m always happy to get emails from students. We’ve had. I’ve had a couple yeah actually a few M1s you know shadow me and I’m you know happy to arrange something and more than happy to have them scrub into the OR. So yeah just… just e-mail me: JMargolick@uams.edu. You know if I don’t get back to yo, just e-mail me again. I’m not the best at responding. But yeah just get in touch with that way. I’m happy to do it.
Hannah: Alright is there anything that we haven’t covered so far that you want the listeners, students to know about?
Dr. Margolick: *laughs*
Hannah: It’s OK if there’s not. It’s not a trick question.
Manasa: It’s probably also a lot that you would want to let us know about.
Dr. Margolick: Yeah, well, you know, I I think I’ve probably rambled enough on your podcast but I will say, I really do you know commend you all for doing this and I think like I said is if…if your med student that’s serious about being the best doctor possible and getting the most out of your educational experience then then doing stuff like this not necessarily this exact thing is…is…is the way forward. So congratulations y’all.
Weijia: thank you.
Hannah: Well thank you so much for talking with us today. We really appreciate you taking the time to participate in this podcast and help out the student.
Dr. Margolick: Great, you’re so welcome. Thanks guys.
Weijia: And as always, please reach out with any comments, concerns, or suggestions to let us know your thoughts.