Heather

First and foremost I wanted to start this blog out with another apology.
It seems in my desire to get out a blog on CEREC I have forgot my first rule of blogging. DON'T TICK OFF YOUR FRIENDS.
I have opinions about the CEREC but I had no intention of throwing my colleagues under the bus. I am truly sorry to those that I might of jaded in my attempt to give my opinion on the subject.


Now about Heather.

Heather is an 11 year old patient in my practice. I have not seen this family in awhile but I was not too concerned. I did see one of their neighbors and asked how the family was. She said, "You didn't hear?". I said "Hear what?"
Well their 11 year old, Heather, has a brain tumor.
WHAT!?
So obviously the rest of the day I was in a funk.
As a father of three I pray everyday that God will keep them safe. And I know pain is coming their way and I pray that He will give me the strength to handle it.
But a brain tumor.

What do I do?
Do I call them and make them answer the same questions they have been answering for the last month?
So this is what I did. I have stationary with my initials on it for letters and stuff. I wrote them a hand written letter saying something like...
I just heard about Heather. I am so sorry to hear about Heather. I didn't want to call you so you have to hash it out with me all over again. I just wanted to let you know that my family is praying for Heather and your family. If I can help in any way please let me know. Also if you are keeping a e-journal (because people that go through this, I think, staff at hospitals recommend this. Two reasons, so they don't have to say the same thing 100 times a day and for therapy) I would like to know the link. I gave my email address.
Turns out she is keeping a e-journal.
The dad wrote me an email saying thanks for the letter and here is the link.

Turns out Heather had brain surgery 2 days after the diagnosis. Then she headed out to St.Jude's in Memphis. Where she and her mom are staying for a month. She is starting the next stage of her treatment, chemotherapy.
This sucks just thinking about it.
I read her journal and you can tell the mom is doing everything she can to stay positive. He pride in joy is in pain. He princess is throwing up at all times of the day. Her baby is sick.
At the beginning of this mess Heather thought it would be cool to get a mohawk. Now she has lost all her hair.
Imagine having an 11 year old daughter, sick, bald, in pain and smiling.

I don't know the prognosis and I am trying to get up the nerve to write the dad to talk to him.

But I was in church yesterday and my pastor talked about a specific verse that caught my attention.
Now lets review the age old questions that Christians and non-Christians are always asking, "Why does God let this happen?"
Now I am not a theologian (obviously) but some of the answers that I have heard over time are...
God didn't create evil.
God works through all things for His purposes.
Jesus suffered.
You can be more like Jesus.
And I think they are all good, but about this verse...

Is is Philippians 1:29
"
For it has been granted to you on behalf of Christ not only to believe on him but also to suffer for him..."

It is a little out of context (and not exactly what Heather is going through) but Paul talks about having the ability to suffer as a gift from God.

Doesn't sound like a gift we want sometimes.

It kind of puts it all into perspective for me. At anytime, any day, the time when you least expect it, your world can get rocked.
Sickness, death, bankruptcy, fire, hurricanes (I know about this one)...
It is funny I know this is coming. I know something is going to happen to me. My family, my kids, my office, my practice. I try to prepare myself everyday for the potential of rocking. At the end of the day I try to thank God for NOT rocking my world that day. I thank Him for the gift of safety that day, for my kids, wife, family, office.
But I know tomorrow is another day and another potential for rocking.

Being this is Easter week I can't help but think of suffering and the product of suffering. For Christians it is everything. It is life.
This is not why I wrote this blog but it turns out to be good timing.

Please keep Heather and the Braswell family in your prayers.
I will try to keep you updated but if you want to update yourself

http://www.caringbridge.org/visit/heatherbraswell

Hope you had a great weekend.
I hope to see you Wednesday,
(Unless my world gets rocked, you never know),
john

Mr. Steve (con't)

Okay so I get the call from Steve in the morning.
I ask if I can call him back.

Now I told you I was jammed for the day. I was able to call him back at about 10:30.
We exchanged pleasantries.

Then I said what is up.
He goes on to tell me that he has a new girlfriend and they are going to have a baby together. They have been going out for a couple of years and he wants to settle down again. He has grown children and now he wants to start another family with this woman. (Fine with me).
He says she has had a past (I'll say) and that is all over with. She has a tooth ache and needs to get in.
He tells me he knows she has a ton of dental work that needs to be done. He doesn't exactly know what she needs but he know she is going to need a couple of crowns and a couple of root canals. (Now you are speaking my language). Then he says I was talking to your girl yesterday and I was not getting anywhere. I wasn't yelling at her but I was trying to get my point across. (This is man code for I was yelling).

This is where I interrupted him and said, "Yeah I heard you got M all in a tizzy." Now this was not meant to trivialise M's feeling it just came out like that. The problem was this was the exact time she walked in the door.
So to her it sounded like men talk and me NOT supporting her.

He then went on to tell me that they spent the weekend in the emergency room and her ob's office trying to get her relief. That he is at his whits end and he didn't know what to do.

As he was speaking I am looking at the schedule and it is jammed. So I look at tomorrow and it is jammed. Then I find a small window of time on Thursday (remember it is Tuesday when we are talking).
So I say, "I totally understand your frustration and want to help you. But I do understand the issue M was having trying to find you a spot in the schedule. I am looking at the rest of the day and there is nothing. I couldn't even make up something. Now I am looking at tomorrow and it is the same thing. I do however see an opening on Thursday that we can see her. How does that sound?"

"Thank you Dr.John that would be great". I went on to tell him that if anyone cancels in the next day she will be the first one we call.
He was very happy with the conversation and I thought it went well.

Now M is being cold to me. I start to feel the tension. I know what happened and I know M is not at all too pleased with me.

Now, if you know me at all you know that I am not at all confrontational. I hate it. I loathe it. I avoid it at all cost.
I know this about my personality and I lived my whole life in a way that gets around it at all costs.
Although, I have really tried, lately, to start confrontation little at a time. In the past I would not talk to my assistants and tell them what I wanted. I always felt like it would be a less than pleasant conversation.
Performance reviews are all like this, "You did a great job, here is your bonus". It was never, you need to improve on this or this is what we expect.
My dad is worse than me so I blame him for this flaw in my personality.

But I have been really trying to sit some of my employees down and tell them what I want. It is so freeing. I am so proud of myself. And I think some of them appreciate it. They know what I expect and it is easy to be a better employee because they know what I expect.

But back to Mr.S. Everything is okay with us. Everything is not okay in the office.
I know what I have to do.
I have to stand up for my staff member, I want to stand up for my staff member. But...but...I don't know if I can do it. I can just leave it the way it is. He is happy. And M will probably get over it...Oh, damn it, I picked up the phone. I dialed the number fast so I didn't lose my nerve.

He answered. I thought about hanging up. Maybe he has caller ID and he knows it me. I have to talk. I said "Hi Steve it is John again. Look I am glad I was able to get your fiance' in. And I want to treat you and your family for a long time. But Steve, M is one of best employees. She is a great administrative assistant and I plan on keeping her for a long time. I trust she treated you with a lot of respect and tried very hard to treat you well."
I went on to tell him that it would go a long way with this office if he could call M and make things right with her.
Wow, that was hard. He says, "I understand and I will do it."

I went to M a couple of hours later and asked if she got a call from Steve. She said, "Yes and he apologised and I forgave him." I was thinking great, all is well right?
Well, what she didn't know is that I called him.
She still thinks that I trivialized her feelings.
So I had to go to her and say I called Steve and told him that I backed you.
That I value you as an employee and want you here for a long time. I asked him to make it right with you.

You should of seen her. It was like she lit up like a candle. This is what woman want. Gosh I wish I knew this in high school, maybe I wouldn't of struck out so much. But in all seriousness this was hard, but it had to be done.

I saw Ms. Don't tick me off or I will run over you with my car yesterday and all is well.
He was happy, I was realived, M was consistantly great. All is well.

Have a great weekend.
Sunday is Palm Sunday.
Just so you know it the date is 3/16.
My pastor is going to preach on John 3:16.
Don't forget to rest on Sunday.
john




But what I started to realize that if I did not do something about this

Mr. Steve

I am sorry for the blogs being so off but I can't tell you how busy I have been the last couple of days.

It seems I have been busy for the last couple of years. I mean not just in the practice but with life. I know you all with small children can relate.

We are interviewing for an associate, as we speak. I am so looking forward to someone coming in and maybe after a while taking some heat off me. This has been an interesting process and I will tell you in a future blog.

Anyway, about Mr. Steve...

I got a call on my day off (I hate that) and it goes something like this.
"When you come in tomorrow you are probably going to get a call from Mr.Steve. There were some fireworks and I probably should tell you about them. I was at a Braves Spring Training game. I am on the third row right behing the dugout. I have had two beers, it is an awesome weather day. I have peanut shells all over my clothes and in my teeth. Can you see this? I try not to care because s#@$%!t happens and I am watching baseball with one of my best buddies.

But this is what happened...

Now let me tell you about Mr. Steve. He is about 47 years old. He has been a patient of mine for about 9 years. He had a crappy mouth, I educated him and he did everything I said. He now has a great mouth.
He a bunch of composite restorations and a couple of crowns. He loves me to death. Has never missed an appointment and speaks very highly of me.
He runs a outdoor equipment rental shop. If I need anything I usually call him first. I don't think I have every done business with him but I have called him a couple of time.

He has a fiance'. It turns out his fiance' has a past. Her ex-husband and his family were patients here. They were always terrible patients. Her ex had been in jail for drugs and was always very careless about his teeth and his appointments. Then she started coming here and it was more of the same.
This is where the story gets crazy...
Turns out in one of their drug induced fights, allegedly, her and her ex were fighting. They were driving (she was driving, he was the passenger) on a dark back street and she stopped the car. He got out of the car and they continued to fight. Things got out of control (brace yourself) and she ran him over and killed him. You read that right. It was in the paper and it was a huge deal for our little town. She was convicted and went to jail. I think for not very long because of self defense or temporary insanity kind of thing.

Now Mr. Steve and his ex-con fiance' are pregnant and going to be married. But the fiance' has a toothache and he wants her to be seen by his favorite dentist. But before he calls here they have already been to the emergency room and has probably heard it from her for about two weeks and then he calls us.

So he calls M, one of my best employees. She can handle anything I throw at her. She has a pleasant phone voice and understands how I feel about service (very important).
He tells her the story and asked to get in. Now she is jammed when he calls. If you are in the restaurant business she is "in the weeds". She asked him if she could look over the schedule and call him back. He says, "no problem".
Now she is looking at my schedule and it is full for about a week. Not just full but packed. So I am thinking she might have been trying to confirm people to see if something might open up for him. (Just as an aside all the stuff about the running over people and going to jail happened before M got here. So she doesn't know about the squishing).
45 minutes later Mr.S calls back steaming mad. He starts in on M. "I have been a patient there for a long there a long time. I don't know who you are and if you have been there long but you might not be there much longer. Do you know who I am? I am FRIEND of Dr. John's. I also know you know about my fiance's past and can't believe you would hold that against her. That stuff is in the past and she is hurting and I need an appointment. "
She says, "Dr. John, I was trying to help him and he was being belligerent and then started in on the past thing that I didn't know what he was talking about. I had had enough of this guy and I was miliseconds away from hanging up in this guy"

"Oh, by the way GOOD MORNING, Dr. John" This was about 6:50am on Tuesday.
Of course I got a call at about 8am from Mr.Steve. I asked if I can call him back.
I mean I was jammed on Tuesday.

I will tell you what happened tomorrow.
I promise tomorrow, not Monday because I don't want to leave you hanging too long.
I hate doing this to you but it will run way long and I have to run put on my DAD hat now.

Thanks for your patience.

Malpractice Insurance

Do we really need malpractice insurance?

I was speaking to an attorney on Saturday. This particular attorney makes a living defending doctors and dentist in malpractice cases. (NO, I am not getting sued. She is a mother of one of my basketball players. We got creamed by a team that hadn't won a game. Thank goodnes it was our last game.)
So told me about a neurosurgeon that made a ridiculous amount of money and didn't have malpractice insurance. She said that he would put away $500,000 a year for insurance purposes.
Not that she was condoning this or but she wasn't saying it was stupid either.

Then we started talking about dentistry. She said that she has never been a part of or heard of a dental case that ever went to trial.
She says it either gets settled or the plaintiff decides that the process is too arduous and expensive to go through with it.

So I started to think...(I know this is dangerous), what if I didn't have malpractice insurance.

My father has been practicing for 33 years and has never even had to hire an attorney to look over something.
Now imagine if he still had all that money.

Imagine if he was just putting the money in an account and if he needed it he would use it.

Imagine if he never needed it and kept it at the end of his career.


Now lets talk about me. I have been practicing for 13 years. I have been paying premiums and have never needed it.
There has been a couple of incidences that got the butt sweat going but never anything happened.
What the heck I will tell you about them. One guy was pissed at me and maybe hired an attorney. I can't remember what he was mad about. I think he said his face swell up after I treated him. But he was a scumbag and I knew it from the beginning. So in his chart I wrote everything. When I called him and he didn't come back. When I told him to do things and he didn't do it. He was nasty to the staff and I knew he was trouble from the beginning.
There was also this woman that was the mother of a VERY famous boxer.
She had my full mouth temporaries for more than two years. She had four teeth on the top and a bunch of broken ones on the bottom. I made a little bridge on the top and gave her a transitional partial. On the bottom it was all temps.
Again I knew she was trouble and really documented her case, with words and pictures. When they broke I said, "These are TEMPORARIES". After a couple of YEARS, I had repaired them a couple of times until I told her I was going to have to charge her the next time. She said she didn't have any money to repair them (as she rolled up in her Bentley). I stood my ground and she got upset.

These are not the reasons I have malpractice insurance. I feel like if I treat people right and I "know my patient" (which is hard to do, when you are sometimes trying to get a stranger out of pain on an emergency visit). I am not concerned with messing up someones tooth.
I can fix any tooth problem. Lets just say I break a file while doing a molar endo. The endodontist can't retreave it. I tell the patient lets finish the root canal anyways and see what happens. Even though it is on the consent form, I may feel a bit responsible. Lets say the failure rate on this tooth is now about 25%. Lets say 5% of these failures blame me. NO PROBLEM. I would talk to my periodontist and he does an implant for me (maybe for free or for a reduced rate).
I can fix issues with teeth.
Lets just say someone was so mad at me (I can't imagine) that they didn't ever want me to work on their mouth again. So I pay the next guy $2000 to repair a tooth.
Do I need to pay all these premiums for this?

What would concern me the most is the big stuff. We once did a study club and our oral surgeon showed a bunch of his work. People would walk into the general dentist office and he or she would miss a bone radiolucency distal to the molars. Anyone would of missed it. But in the next year the person had swelling and then went to the oral surgeon. Guess what the little radiolucency was not little anymore. It was half of the patients right mandible. The oral surgeon said, "This one settled out of court for 2 million dollars or this dentist lost everything because of this one. "

This is what we have insurance for. But what are the chances of this person walking into your office. My father and I together have been working a total of almost 50 years and nothing.
So we are insuring ourselves for the one in a million guy that walks into your office with the beginnings of an aggressive form of cancer that we MAY miss.
The answer is Yes.

Have you ever been into a doctors office and at the front office a sign reads, "The doctor does not carry malpractice insurance"?

I am not condoning it but It might be a thought I might entertain.


As a famous pastor Steve Brown would say, "You think about that."

Talk to you soon,
john

Frank Spears (continued)

Cliff notes from Wednesday.
I love Frank Spears. He makes tough dentistry look easy.
I had a case that I worked up. Face bow, CR record, mounted models. Then my dad and I were stumped on how to proceed.
I thought I have spend over (between my father and I) $20,000 on hearing his lectures, I will bend he ear the next time I see him, which I knew would be in a couple of weeks.
I brought my articulator carring case with the chart to the lecture. I know, I looked real cool.

Now if you have ever seen Dr. Spear it is like a concert. At least in Orlando, there is a stage and a backstage. It is not like before the lecture he is hanging out with the little people. He is hanging out in the "green room". When it is time to start he comes from behind the curtain and he welcomes us and tells us where he ate his steak the night before.
Because he is not available before his lecture I felt like for sure I could catch him at lunch.
Now it is $1400 to see his lecture. Always in Orlando it is a packed house, about 300 people.
Do the quick math.
Included is muffins and coffee in the morning and a pretty nice lunch, both days.
Carry the one, about $300,000 a weekend for Dr. Spear. Not a bad gig.
Lets say I am uninformed, and don't realize the overhead, and he somehow ONLY pulls in $150,000. Still a pretty good weekend.
At the beginning of his lectures he tells us that there is not really time for questions and answers because of time. Now, I totally get this, you can have people totally monopolizing a lecture because they don't understand a point. Then this question opens the floor and everyone has a question. 45 minutes later you have answered everyones questions. So how he handles this is, at the break, he tells you to write you question on a sheet of paper and put them on the stage. Then he will address all the questions when we all return from a break (and or lunch).
So because he was so elusive I put a note on the pile. It says, "I am having some trouble formalating a treatment plan for a patient of mine. I brought all the xrays and study models. Do you think you could please help me. I promise not to keep you long."

So I thought he might say during his answer session, but he didn't mention it. He has some staff that usually hangs out outside the lecture hall. I told them what I did and they said, "No, he won't see you." Okay, no problem. I said, "Do you think I could email him and send him some pictures and we could just exchange some emails?" "No, they said. He doesn't take emails from dentists that he doesn't know."
I asked is there anyway I could get someone to help me with a question I was having.
They said you can try his associate.
That sounded okay with me.
I emailed his associate. Nothing in return.
Now don't get me wrong, I think the guy is a great dentist and I don't know what it is like to be him.
He has put a second to none lecture series together and I would still pay to go see it.
He is probably rich beyond his normal audience. In one of his lectures he speaks about all his cars. He has an exotic car collection, but another thing he collects is ex-wives (3 I think. I know low blow). But how can you not come done to the level of your audience? The people that afford you to have your exotic cars and ex-wives. It is like pro atheletes. If you make $250,000 a game, I would think they would be greeting people at the door signing autographs.
One time I was at his lecture and he says he is practicing 4 days a month. Now how can he not have 5 minutes to talk to me?
I once went to a lecture for lecturers and they said the first rule is make yourself available at breaks, lunch and after. Don't make your flight such that you can't make yourself available to your audience.
"I made $150,000 this weekend, I have got to go."
Last thing, he said in one of his lectures that he had this patient from Texas (he practices in Seattle). He gave this guy his treatment plan, it was $80,000. The guys says I know you are good great dentist but do you think I could get the veneers done by my regular dentist and then you can do the other stuff?
Frank says, NO.
So the guy thinks about it for a month or two and calls Dr. Spear and says, "Okay, I will do all of it with you."
Frank tells him, "No,thank you. You had your chance, now I won't treat you."
EIGHTY THOUSAND DOLLARS.

Like I said, I don't know what it is like to be Frank Spears but I am starting to think I don't want to. I love the guy as a dentist. I am not so sure I like the guy as a person anymore.

End of blog.

I have some questions for you and I need your participation....
Can you please answer? It will help me move forward and give you the entertaining blogs that you see today.

Do you visit any other blogs (it won't hurt my feelings, are relationship has not moved in this direction, YET)?
Do you have a desire to comment on this blog and don't?
Is the commenting process get in the way of commenting?
If you don't want to leave the answers in the comment section just email me. Jgammichia@aol.com

Or if you have a topic you want me to talk about...let me know.
Don't forget to register for the AGD in Orlando. My stomping grounds. We can do lunch.

Frank Spears

I don't know if I told you this but I am a huge Frank Spears fan. I have seen him about 10 times.

I think, as a dentist, it doesn't get any better than his work. He makes his lecture so user friendly. When I see his work I think he is a real prefectionist. Now I can relate to this. I want to be like him.
I try to be like him. I spend a lot of time trying to make all my restorations look real. I always thought his stuff stands up to the 12 foot screen test. If you can put your work up on a 12 foot screen and you are happy with it. You pass.

When I listen to him and look at his stuff. I say to myself, "How much would it cost me to be an associate at his office?" Just to soak it all up. See how it is done. It is easy to see it done on the screen but it never is easy going back to the office and doing it.

This is the part I always struggle with, bringing it back home. Because of this I bought the $1000 DVD program that he sells. I wanted to watch it with my assistants and start to do it.

Still not so easy.

We sit down if front of the TV and again it looks do-able. We start to do it and inevitably crap happens that we don't have the answers to.

Nothing is worse when you have bought $5000 worth of stuff at a meeting (because you ARE going to do this) and then take it out of the box and it is like, s#$%*!t, what have I done. So you get this contraption in front of the patient and you are fumbling around with it.

Enough about that. But this is where the topic of this blog came to mind.

I was trying to do everything right. I took the facebow, I mounted the models. I took the CR record. Then the treatment plan was a little iffy. I talked to my dad and we both couldn't agree what the best mode of treatment was.
I thought I will ask Frank. I thought I have spent over $20,000 at his courses, he could spend 5 minutes with me.
I knew I was scheduled to go to a course of his in about two weeks. I will bring all my stuff to the lecture.
The lecture day came and I brought all my stuff, chart, models, bite restration. I felt like the biggest dork bringing in my articulator carrying case. But I was determined to do the best thing possible for this patient.


Here is the deal....I am jumping in a car to go to Gainesville to see the Gators save their season and beat the Tennessee Red Necks (I am sorry if this is insensitive, it was meant to be). I don't want to rush the next part of the story, so I will finish on Friday.

Thanks for your patience,
john

Is your call too small?

As you all may know I go to church.
There is a Sunday school hour and then the worship service.
My church is fairly contemporary and it is a fun place to be at.

Yesterday, during the Sunday school hour, a dude got up in front of our class and talked about (the title of his presentation) Is Your Call Too Small.
He spoke about in Genesis when God spoke to Abraham (wouldn't this be nice if God spoke to us AUDIBLY. "JOHN, GO AHEAD AND BUY THAT NEW HOUSE. I APPROVE AND WILL BLESS YOU AND YOUR FAMILY IN IT". "Honey, I am getting the vibe it is going to be okay to buy this house.") and told him to get up and go to Cannan (of course, he went to Ur instead. So yeah, you heard it right, God speaks to Abraham and tell him to do something and HE DOESN'T DO IT). But he also tells Abraham to go and I will bless you and your family and all the nations. I am paraphrasing but you get the gist.

All the nations.

We spoke of this for about an hour. So the speaker did an exercise that I can't stop thinking about.
He asked twenty five people to stand up at the front of the class room. Each person would represent approximately 250,000 million people.
So the speaker handed one guy a miniature American flag and made him stand over there.
Now this means American represent 4% of the worlds population. Think about this for a minute. 4%.
So he went on to ask us where all our thoughts are...where all of our news is focused on...where all our prayers go...where all our money goes. All to 4% of the WORLD.
So what is the biggest country, population wise in the world? You probably guessed right, China. They have approximately 1.2 billion people, five people got miniature Chinese flags.
Second most populated? Think about it. India.
I think America was third and I think Pakistan was fourth.
All of Europe got three flags and a bunch of other people in the room got a couple of flags.
This exercise obviously makes us feel pretty silly thinking about USA all the time.

So then he spoke of the worlds money.

America, 4% of the worlds population has 36% of the worlds wealth.
Between USA and Europe we have 60% of the worlds wealth.
He said, THREE of the worlds richest Americans have more money that 10% of the worlds poorest population, put together. Did you just say, "WOW!!"
He gave data that said if you have $2100 in assets you have more money that 36% of the people in the world.

WOW!

Just as all of us stood there is shock, he asked 10 more people to stand.
Now these 10 represent missions in the world. They represented the amount of missionaries and the amount of missionary money.
So he took 9 of them and put them around the guy holding the USA flag. And he states 9 out of 10 missionaries and missionary money goes to the USA (remember 4% of the population) and 1 out of ten missionaries and the money goes to 96% of the worlds population.
WOW!!!! Marinate on that for a minute.

Growing up, I use to ask my dad if we were rich and he would always say NO.
When my kids ask if we are rich, I emphatically say, "YES". We can't stop thinking about where we are as it pertains to the world.
We are so lucky to be born in this country. Or if you moved here, we are so lucky to live here. Imagine if we were born in a country where we weren't free.
Free to be a capitalist. Free to worship. Free to have as many babies as we wanted. Free to write on a blog.
You are damn right we are lucky.

Is our call too small? You bet your sweet toosh it is. Our call is usually about a 5 foot circle around our bodies.
We complain about people not paying their bills, we complain that the gas prices are too high (for our fine luxury automobiles). We complain when things just don't go our way. We complain, complain, complain.
$2100, I can't shake this number. If I had $2100, I am richer than 36% of the people in the world. I turned to lady sitting next to me and I said, "My family and I are wearing $2100 worth of stuff." (I was exaggerating a little, but it is close enough).


Think about this.
I will talk to you on Wednesday.
john

Buckeydentist are you still with me? I miss your comments.