Have you been labeled a workaholic? Ever been accused of being a perfectionist? Most doctors have, and despite what society thinks, these qualities are a sure path to burnout.
On this episode, you’ll listen in on a fascinating discussion with practicing primary care internist and physician life coach Dr. Kara Pepper. She seemed to have the life most would envy, starting as a young professional ballet dancer in her teenage years, then transitioning to a well-respected, high-achieving physician. But inside her walls were crumbling, inevitably leading towards a dark and dangerous path, if it were not for one crucial intervention in her career that lead to salvation.
She now coaches other doctors that you can escape burnout if you recognize the warning signs early, and is the living embodiment that there is a path for you ahead to live a life of fulfillment and sustainability. This is a must listen episode for all high achievers at risk.
Sign up for Dr. Kara Pepper’s Next Group coaching for women physicians:
Kara Pepper MD
Dr. Kara Pepper’s Physician Coaches Profile:
The #1 Doctor Directory for Physician Coaches, Consultants, and Mentors
Dr. Mike Woo-Ming: I’ve heard this name for a while now, and she. Probably one of the most predominant life coaches that I know there, but she talks about other subjects that I don’t think too many life coaches really discussed and we’ll get into it.
She’s a practicing primary care internist. She who underwent burnout, but she rebuilt her life in career. She now focuses on coaching that is forward facing, evidence-based helping high achieving perfectionists, I guess some physicians may be that are undergoing burnout and are looking for career transitions. She provides one-on-one coaching lead retreats, and she speaks about topics around a breath, perfectionism, imposter syndrome, wellness, and career transition. She also is involved in group coaching and she’s got one for women’s physicians.
And we’ll talk about soon, but I’d like to introduce to the show Dr. Kara Pepper, Kara, how are you doing? Thanks for joining us on the show.
All right. I gave that quick introduction, but I just stumbled right through it. So I always like it best to hear it from the person who experienced this. Tell it, tell us about your journey from internist to, to coach probably something that you didn’t plan on when you went into medical school.
Kara Pepper MD: Definitely not! None of this was really in my plans. My original plan was to be a professional ballet dancer, which I was straight out of high school and loved it, but ultimately had career ending injuries due to underlying eating disorder. And so found my way into medicine. And dancers and doctors are the same people.
They’re lifelong learners. They’re high achieving, they are workaholics. So I brought all of my perfectionism and workaholism with me into a career in medicine. Ultimately became that primary care internist, which I love. It’s like solving puzzles all day long. But just got typically burned out. I took a sabbatical thinking back to my practice after finding coaching, because it helped me really clear up all that burnout mindset that I was in.
And I’m still practicing there today. And so along the way became a coach really to help other physicians who are struggling with those same issues, burnout and perfectionism.
Dr. Mike Woo-Ming: I want to talk about it a little bit more and just delve into it. And I know it might need to get personal, but, burnout people experience burnout, for different reasons in medicine.
Particular and burnout. And again, I think to come to a time, which is probably not the most present for you, what were some areas that you felt.
Kara Pepper MD: Work was really my drug of choice. We don’t feel good. We always find ways to feel better. And so some people eat and some people drink for me, it was working. And it was easy to feel good about the work that I was doing, but also avoid all the things that were problematic for me.
And so at that season of my life I joined a high achieving practice. One to be a great doctor to my patients, had no boundaries and really. Over-delivering care with the way to practice at a spouse who travels full-time with his career. I had two young children and there’s just not enough hours in the day to be everything to everyone.
And so I basically worked myself into a place where I felt like I was failing and I was really ashamed of that all the time. And I clearly thought everyone will send their act together. When in reality we know that’s not true, we’re all just trying to make it. And so it really got to a place where I just couldn’t get out of bed.
And so I said, I need to ask for help, which was a really hard thing for me as the person who had all the answers.
Dr. Mike Woo-Ming: Now, it sounds you learn from your ballet training and you understand about this, having this being in a world where, performance is everything, lots of demands to yourself, but did you have, was it just like you woke up one day and you decided to do it or were there people telling you, Hey, you can’t be doing this. Were there any circumstances like that?
Kara Pepper MD: And told me that I could not keep working.
Dr. Mike Woo-Ming: Yeah. We’re there. For example, in it, for me, it was my wife who says, you can’t keep doing this anymore. I’m seeing you. And you are not the person that you were irritable. I’m angry. I’m dreading, I would have an awful remark is oh, it’s a Monday.
I can’t. I might be joking about it, but I was like, I’m dreading coming in. Where there anybody that surrounded you or did you colleagues or, family member that because it’s often times you don’t know, what it is or talk about, or maybe
Kara Pepper MD: you did. Yeah. You’re exactly right. I knew I didn’t feel great.
That was for sure. But I was pretty numb. I’d just been working to that place of feeling nothing. And often people would say wow, you’ve got a husband, who’s not home. And two young kids at home and you’re working 60 plus hours a week. How do you do that? And what I would hear was not, wow, that’s so much, you should really take care of yourself.
What I heard. Clearly, if I could just work harder, I wouldn’t feel like this. It’s like the perfectionist fantasy. If I could just do enough, I can feel okay about myself and then I won’t have to have this judgment or criticism and then I can be okay, but we never reached that. Enoughness right.
So there was no amount of work that ever made me feel better. It just continued to avalanche to this place where I simply could not keep up with what I was doing. Yeah, there’s people around me saying what is going on with you, but I wasn’t willing to hear it.
Dr. Mike Woo-Ming: I definitely resonate with that for me. I was in a group practice, but it was more of a, “this is how it is, this is the way medicine is these days. And you either got to suck it up and be a team player. And that’s how it was. And that’s not what, how I envisioned.” So I think. It takes so much courage to just say, enough’s enough and leave.
And there, unfortunately, are many physicians that are out there that never get to that point. And don’t even realize that they have an option for that. When did you decide to say, you said you were you burnt out, how long were you away from? From medicine?
Kara Pepper MD: Yeah, so I was in my seventh year practice and I had a good mentor who I went to and said, I need help. I don’t know what the answer is, but I can’t do this anymore. And he said, you knew you need a leave of absence like a year. And I was like, oh no, I was thinking like a week vacation. And I’ll be okay as if that had ever fixed anything.
And so he said you need at least six months. And so the longest I could have stabbed him to taking time off was the maternity leave. So I took six weeks for sabbatical. Now, me now I look at that and laughable. At the time I’ve bought myself enough time to not feel like I was on fire.
I certainly wasn’t well, when I came back, I certainly thing wasn’t anti burned out. I didn’t feel great, but it really. Spotlight’s that mindset of, I can’t ask for help. It feels like failure to take time off. I’m failing my partners and failing my patients. So that massive sabbatical, that seems like it was a long time was only six.
Dr. Mike Woo-Ming: Yeah. So was this person in your organization? Was he somebody close? Cause it’s very, I think that’s rare. Don’t you think for someone in that position to say, Hey, just take a year off.
Kara Pepper MD: Exactly. And as it turned out, he had taken time off a year off when he was about 40. And he had done some healthcare adjacent work and then come back to the practice, but had I not had that one voice that I trusted and respected to say, Hey, I’m worried about you. I get it in the way that I understand you.
And I’m worried enough that I really want to nudge you to do something outside your comfort zone. No that I would have ever done it. I probably would’ve just quit my job and never returned to medicine because that really was the fantasy I was having at the time. Let me just move home to Florida and open a yoga studio, because anything is better than doing what I’m doing right
Dr. Mike Woo-Ming: now.
Yeah. Luckily that person that was in your life and again, I think that’s pretty rare. So come in your organization that you have that. So it’s been a year and you got a date when you’re supposed to come back. How were you feeling? Was it feeling a dread where you’re feeling like, Hey, I got this, I’m ready to come back.
Climeon about what was your mindset?
Kara Pepper MD: Oh, I was definitely not. Okay. When I came out of that six weeks away from work, I was functioning as a human, but I wasn’t well, and so I’m really grateful to be a part of a practice that said we value you. And we want you to hear, tell us what you need in order to be successful.
And so I unwound my 60 plus hour a week schedule to four days a week. Part-time. For truncated days. And so it allowed me to be able to practice, but actually still have some brain space. And honestly, it was probably two solid years before I felt like myself. And then in that window of time, I certainly continued to see my therapist.
But as I mentioned, I found coaching in that window and started with a coach. And those two things synergistically for me, really helped me. On what was mine to own and the suffering that I was creating for myself and really define what I needed to continue to practice medicine, which is really what I wanted to do.
I just didn’t, I couldn’t envision a way forward without their help.
Dr. Mike Woo-Ming: Now, as we created physician coaches that problem, so doctors can find coaches more easier, but when that’s then how did you find a coach or you referred? Did you just go online? What was the process?
So there are some pioneers in the physician coaching world. And one is Kathy Stephan who does a lot of wellness retreats. So I went to hers and Miraval, which is spectacular. Everyone should go. And I was first introduced to coaching in that window and I thought, wow, this really. Something I can do. And also the shift that I really need. And there’s a woman Diane and sorry.
When, who runs physician coaching academy, she teaches physicians how to coach physicians a very specific focus. And I said, that’s exactly what I want. And so between those two I was able to open my door to training, to be a coach. And in the background of all that, there’s a third woman, Aaron Weisman, who is either a physician coaching Alliance now, but she was like grassroots gathering up all this kind of ragtag team of coaches and saying, Hey, we’ve got something here.
There’s such a huge community. Let’s get together and help each other. Through peer coaching through building business, through entrepreneurship. And so it’s through those three women that this kind of whole world got opened to me. And yeah, as you see this, cause I know Erin I’m like picturing like a, she’s got like a rope, everybody together and we sat around the show.
And so you certainly, whenever it’s done. So you decided to open your doors. So what time was that you said it was about to.
Kara Pepper MD: Yes. I got certified in early 2019 and started coaching then.
Dr. Mike Woo-Ming: And so how did you get your first clients? How did they find you? Did you start marketing it to open a store?
Kara Pepper MD: Yeah, at the time, my vision was. Integrate coaching into my clinical practice. And I was practicing quotes, practicing coaching, getting the coaching hours just in the circle of people. I knew my partners physician friends. And so that first year was just a lot of it felt more like a hobby. And I need that in an endearing sense.
Really just fun and creative and exploratory. For me, it was something for me that I’d never really done before. And I had never opened my own business. So it was really just the process of learning and creativity, which I really loved. And then. That I started getting pain clients by the end of that year.
And then the second year was 2020, when COVID happened. And so particularly because I coach around burnout and perfectionism and I’d done some second victim work, I really built my client base at that point in time with a lot of one-on-one clients. And then started doing group coaching out of that kind of cohort of people who really were struggling with perfectionism.
So that’s found my way as the classic general internist. I coach everyone on everything. And then my focus has gotten narrower and narrower. So now like the perfectionistic high-achieving self-doubting women. Generally, those are my people. I love them. So that I ended up doing a lot of groups, group coaching around that.
Dr. Mike Woo-Ming: Yeah. That brings up a couple of questions that just off the top you said that you wanted to integrate coaching, with your clinical work. Now having interviewed coaches I’ve seen that where they it’s something that they’ve done at work in the integrate coaching. And then I know that there’s, some coaches were like, I’m doing this completely separate from the hospital. They would rather me not know my, like I’m hiding, but they would mind me not be associated with that. How do it work for you? And it sounded like, obviously you had to disclose that you’re doing this well. Was that a difficult question to ask, what are you to do this or that, or the.
Kara Pepper MD: I think it was on time. My hospital system that owns my practice was looking to start some wellness work. So it was part of the general conversation, so well received in that way. But I very clearly through, my non-compete contract just had to disclose coaching is very separate than practicing medicine.
It’s not remotely the same thing. And that was also that hurdle was crossed in terms of integrating it with my practice, as an internist. I would argue that every physician really is a coach. It’s how we educated, how we encouraged, how we motivate our patients. And it didn’t take me long in clinical practice to know that if I had a diabetic, I could hand them more insulin, or I could start to unwrap the onion and try to figure out, like, why are they struggling with diabetes?
And then maybe it’s because they have emotional eating and then maybe it’s because they have a history of trauma and then you start to unwind. So really it gets to this place of exploration, which feels very similar to coaching for me. So motivating patients for behavioral change since we’re all coaches, every physician listening is remember when you could practice medicine on your own terms.
Dr. Mike Woo-Ming: So you said like the first year you treated it a hobby and then, realize you’ve got to treat it as a business.
You’re getting things. Thank God. Just wanted to make sure that you are helping pinpoint. You want to make sure that you are helping them as best you can, as you are. When did you start to say, Hey, maybe I should start doing group coaching because I know number of one-on-one coaching or they’re looking into group coaching.
And how w how did that process, how did that.
Kara Pepper MD: So the question that I always want to answer for my clients is like, what do they need right now? How are they feeling? How can I best serve them? I never really went into coaching because I’m still practicing full-time I never went into coaching thinking, Hey, I want to, have this multi-six-figure business.
It really was like, how can I use this as another line of service? And through the COVID crisis early on, I started to do some group work, just small, mostly in line of support and doing group coaching. How I cut my teeth in that, but towards the end of 2020, when everyone was so exhausted and thinking hopefully 20, 21 will feel like a fresh new start.
A question that I kept asking myself was like, what do I need? COVID was a big awakening for me. I was living my best life during this COVID month, working from home doing telemedicine. And that really resonated with a lot of my coaching clients. What is next for you? What do you want to define?
What do you know about yourself? How did you outgrow this vision that you started out? I, at the age of 20 how does that fit or not fit you anymore? So this concept of like redefining. Life on your own terms and not living for everyone else’s expectations and really starting to value yourself in a different way.
That’s that was really the core principle behind what’s next. And so I just said, let me put this out there and see, and believe me, there is a lots of early entrepreneurial, jitters what am I doing? This is a big undertaking, but it was really well received and this amazing community of women who participated and the perfectionist piece of things really resonated.
And so then I moved into more.
Dr. Mike Woo-Ming: So let’s talk about it. Let’s talk about this perfectionism. So you probably have an idea, but let’s talk about it in your clients. What have you found and what are the struggles that we have with perfection?
Kara Pepper MD: It’s all, it’s a loaded question. I could talk forever, but I think probably the most salient point, remember numbers, that perfectionism is a hindering behavior that we all think that being a perfectionist means doing things perfectly.
And if I could just be perfect, I could feel okay. It is not the same as high achieving has a very different. Curiosity determination learning field to it. Whereas perfectionism really gets down to a place of worth. If I can do more, be more I can feel okay about myself. And in healthcare, although this doesn’t apply to everyone, many of us work and feel good about the work we’re doing because it’s a service to the world around us, but that can be a very slippery slope to.
A good doc, how a good doctor should behave the rules behind the implicit training that we get, right? You should be everything to your patients all the time. Never say no to a colleague always be available to your patients. And it really becomes this very slippery slope down to burnout. So they’re very tightly linked in my mind.
Dr. Mike Woo-Ming: There’s lots of, causes for perfection. Yes, it’s we want to do what’s best for our patients. On the other hand, a lot of times what we do in perfectionism is really kind of CYA. We don’t want a lawsuit. We don’t want to. So we’ve got to, that’s certainly a factor.
Also. There are things that, we’re one of the few occupations it’s life and death, right? If we, if one thing goes wrong, we could cause someone to die. How do we overcome these feelings of perfectionism? Because as I know, people who are perfectionist, I am myself, a perfectionist. We all are to some extent.
So we probably wouldn’t be here when, and what we know is that you just can’t shut it off in medicine. It applies to. To our regular lives and our spouses feel it, our kids are feeling that the way we live, we just can’t get it. What are the ways that we might find that we. Warning signs let’s say in person and what are the best ways to overcome it? I see the coaching.
Kara Pepper MD: Yeah. So part of it is I think the surgeons have a very great expression around this, which is perfect is the enemy of good. And so this idea that we have to be a plus all the time, it’s just simply not a realistic standard. And I think that saying really illustrates the fact that.
The self-doubt, the self-criticism the procrastination that I have to be good enough and do enough piece of mindset and perfectionism really can actually hinder your progress, hinder you from moving forward, hinder you from being able to like, make a decision and stick with it. So that constant self-doubt it’s there.
It’s really at the core perfectionism. So part of it is just recognizing is this showing up for you? And I’ll just give you a really practical example. Like charting is probably the most accessible way to see if you’re a perfectionist, right? What do you believe about your name? What does it say about you?
And so the perfectionist will say, I’ve got to write in prose. I have to have all the details. It has to be organized the right way. What will people think if they read this note and it has typos in it. And so the classic procrastinating, perfectionist, that’s always trying to like make everything a plus work often ends up with charting errors or charts that are piling up at the end of the week.
And so they’re never able to actually get through them. Recognizing if this is showing up is always the first step, just noticing. And then secondly, there’s some very practical tools around that. So we often talk about B plus worker. Some people will say B minus work. Like not none of us ever want to be B plus students.
We were raised to be A-plus students, how we got through all the training, but really focusing your energy on what matters. Like arguably with direct patient care or with your coaching clients or with your family, like showing up and being present is the goal, right? Having typos in your notes or doing bullet points in your notes or using auto text replace, those are shortcuts to just get the busy-ness out of the way.
So my point is recognizing where your energy really needs to go and then stop focusing on the things that are really distracting you from your goals. A very brief intro into ways that we can highlight.
Dr. Mike Woo-Ming: I know there’s so many ways to look at it and I think also just recognizing yeah, there’s third activities that want to be the best that you can.
Let’s say you’re doing open heart surgery, versus, notes that, follow up notes or just. I dunno, like putting the garbage away think so. Sometimes it’s a mundane character, but sometimes if you have that personality, everything has to be right. And I don’t know what how’s that driven?
It’s almost I was like, I gave an example, so it was like a spelling bee champion. Okay. And like fourth grade. And if I see a misspelling, I can’t like, like I have to correct it. Like I have to stop what I’m doing. And I’m like, oh, I can’t read more because they’re like, no, but let’s say I’m looking for a someone to fix my car.
But if there’s a mixed spelling misspelling, I’m saying this, they’re horrible. They, if they don’t know how to spell I don’t know, carburetor cleaner, then I’m not going to go. And they might have five star reviews, but I don’t know where that comes from. I don’t know if you’ve explored it.
Is there something in our brain that we are like, who cares? Like we think about it, it’s I don’t really care, but I’m like, I’m trying to please somebody, I don’t know if you’ve experienced them like that or you discuss this, where does this perfectionism.
Kara Pepper MD: So part of it is that there is no such thing as perfect, right?
We can strive for it. We can work towards it, but this idea that there is perfect out there that is actually achievable. And that we can stand on the top of the mountain and say, today was perfect. It may be transient in the moment, but the permanent state of perfectionism or permanent state of perfect doesn’t work.
And part of it. I liked that you mentioned this word pleasing, like so much of it is really comes down to worse. And so if we think if everything looks okay on the outside, if I can make other people happy, if I can serve people in the right way, then I can feel okay about myself. And so that people pleasing behavior is another one that shows up in perfectionist because we think if we can just control everything around us and we can feel okay, It always gets back to like, how can I be okay with exactly the imperfect, messy person I am?
And that doesn’t mean we shouldn’t start to stop striving for excellence. It doesn’t mean we shouldn’t care about our patients. It doesn’t mean we shouldn’t take time and detailed work and what we do, but the difference is. Allowing for self-compassion allowing to feel feelings like shame when we make mistakes, allowing failure to be data collection and not like a statement about who we are as people.
And so it’s a much more compassionate way to live when we say, you know what? I’m always doing the best that I can, but my best may look different day to day. There is no such thing as perfect.
Dr. Mike Woo-Ming: I know, and, working with entrepreneurs let’s say for example, I saw, I had one client where it took forever to get his website up because he wanted to format it correctly.
And then when I look at his website, he says, don’t you see what I’m seeing here? This is off to the left by 10 degrees. And what happens is they never launch it because it completely blocked them. And I’m like, why is it doing that? But I see that in my stuff, it’s oh man, I’m sitting at this email.
And then I realized I put a, a semi-colon instead of a hyphen here, and it’s not the property, but no one cares. Nobody really cares.
I’ll tell you a good example of that. I was sitting, I was sending out an email on a workshop on perfectionism. I think it was, and it had a link to the recent. And I sent it out to my entire mailing list and the link was broken. Someone emailed me back. So I said, okay. So I corrected link and I reset sent the second email later in the day and said, excuse me for, whatever. I apologize. Here’s the new link. And the second link was broken to this lecture on perfectionism.
And so someone emailed me so third time that day it had to go back and I fixed the problem and it worked. But it was so funny to me because the old me would have just been like, my business is ruined. This is terrible. No, one’s going to read in the narrative, correct? Yes. I clearly don’t deserve to do this right.
I was, I’ve done enough work around this just to recognize I’m human. Like I didn’t do it on purpose. It just happens. This is part of it. I apologize and move on. But it was so funny. The feedback that I got from so many clients to say, was that like, were you testing us? Were you like showing us an example of how to be imperfect and keep rolling with the punches?
And I just thought it was like such an endearing. The statement about the community of people that I coach, but also just like here’s the perfectionism coach, like modeling imperfection in real time. And also just demonstrating like self-compassion is the antidote always to the shame that we feel around not being perfect.
So I just had to let it go.
I’ll give you another example, so I had my assistant and we had a co we had a course that were coming. And the course pipe part of the coffee, it said something like you can’t afford to miss this this program. And somehow it wasn’t communicated well and she wrote you can’t afford it.
And it was sent out to 3000 people and I still survived and we put into this, it was a joke, but you know what, that the sun rose the next day. And, we like to say we’re just human things. And that it just shows a little bit more conspiracy to, but yeah, we don’t want to do that again.
Kara Pepper MD: But we’re at the point it’s we’re human.
And to pretend that we will never have these experiences is unrealistic. And so there’s never been a time. More than now where we need to be able to like actually be human show that we are embarrassed or ashamed show that we’re overwhelmed show that we make mistakes and we get up and keep moving.
And so much of the culture around medicine is we cannot have any emotion. We have to be perfect all the time and we have to keep moving forward. And it really, I think, contributes to a lot of what you and I are seeing, where people are leaving healthcare to try to find other careers. Because it’s just not sustainable to believe that we can never feel human.
Dr. Mike Woo-Ming: Exactly. And there’s still that stigma out there that we still have. There’s still, there’s still people who don’t recognize that, we are, for feminine, we’re still on that pedestal and we’re not allowed to make mistakes. So it is. I still keep coming back to that person who told you, Hey, it’s okay to take time off.
It just came to get, your mental health back because there’s still, now many organizations don’t have that. I know you’re busy, but I want to talk about the event that you’re having coming up very soon. September 12th, this group coaching program. Can you tell us about that.
Kara Pepper MD: Yeah, I’d love to! It’s group coaching.
So live on Sundays for women physicians. There’s 20 CME credits. So use your CME budget. If you have that form to come you can add on one-on-one coaching if you choose to, but it is really meant to be safe space for women who want to define what’s next for them. If they’re exhausted, if you’re trying to.
About career transition. If you want to talk about the real stuff that you talk to your girlfriends about whether it’s your body or your work or your aging parents, or how to get ahead and charting it really is a space where we work on the things that every woman is struggling with. So it’s built around the question, how can we make life easier and more fun?
And there’s never been a time where we need some respite. So I’m so excited about it.
Dr. Mike Woo-Ming: Let’s just talk about too. And then go to your website to get more information.
Kara Pepper MD: Yes, absolutely. It’s karapeppermd.com
Dr. Mike Woo-Ming: I want to talk about it because you’ve been working with the clients. I like to talk about what just love to talk about, and that is their clients.
Let’s talk about some of the people that you’ve helped. Can you give us some example?
Kara Pepper MD: Yes. So I’ve worked with trainees through attendings monthly, I do free coaching for residents and fellows because I really truly believe if we can get coaching in the hands of early career physicians, it will totally change their lives.
But particularly the folks that come to me are really struggling with. How can I feel better in this life I’ve worked really hard for. And very rarely do I have people truly leave medicine. I do believe that the core values that brought people into health care still remain with them. It’s just, we get lost along the way.
So really trying to rediscover and rekindle the love for themselves and the welfare service as something that a lot of my clients end up going to. But not always. I have folks who are making lateral health affiliate kind of careers as folks that are changing their life on their own terms. If they hand their work, part-time in the season of life.
But it’s really less about how they practice medicine, but how they start to love themselves and say, this is the life that is so short and I want to make the best of it. So that’s a lot of the coaching work for me I end up doing.
Dr. Mike Woo-Ming: And like you said, you cannot love medicine unless you love Thank you for joining us, go to the website karapeppermd.com.
Kara Pepper MD: Karapeppermd.com. You can find me on all social media, Kara Pepper, and on all that
Dr. Mike Woo-Ming: Yeah, karapeppermd.com. Go check out her quick coaching program. That’s coming up very quickly on September 12th. How many questions you can reach out to her?
I’m sure she’ll be happy to answer your questions. Again, any last names, thoughts before we end the call?
Kara Pepper MD: Remember that you are your most important patient always. So our life doesn’t have to be defined by the expectations that we started at 20 you’re allowed to change your mind and take care of yourself. Exactly who you are.
Dr. Mike Woo-Ming: Oh, that’s great. Again, thank you. If you’re someone who’s struggling out there and this interview resonate with you, reach out to Kara, I’m sure she’d like to hear more about what you can do and how she can help you. And for all, always guys, thanks for listening and as always keep moving forward.