Transcript

Tim Beames (00:02)
Welcome everybody to the pain podcast with Le Pub Sionte-Fique. And today I'm the host. My name is Tim Beams and I'm a pain specialist physiotherapist and I have Bart Van Bukum joining me also pain specialist physio. And today we are going to be talking about difficult conversations. ⁓ And in particular, we're going to discuss when

People, it's probably one of those sort trickiest conversations actually that people can have in pain care. What to do when someone comes to you, perhaps they have a persistent pain problem and they just want a quick fix. So we're gonna explore some communication strategies, a bit of psychology around it and figure out how we can better work with people who, yeah, come with those, I would say almost like a need.

Yeah. but first, good morning, first of all, and great to see you. Yeah. I feel like we've got a lot to say here. We have talked a little bit around quick fix mentality before, haven't we? So, so should we just sort of take a couple of minutes to ground us in what that means? So if I'm, if, if somebody, someone comes to you, they want a quick fix, what, what, what?

Bart Van Buchem (01:06)
Good day again. Yeah.

Yeah, for sure.

Tim Beames (01:28)
What's sort of at the heart of that and what are you thinking in those moments?

Bart Van Buchem (01:33)
⁓ that's some yeah, that's probably what's it's an expectation, right? That that's the first thing that comes to my mind if you want a quick fixes. ⁓ I think it's a human right. If there is a quick fix, why not get the quick fix? ⁓ So I don't think there's anything bad. It could be like something you hope for you wish for. So I think if people are really

Deliberately or explicitly asking for a quick fix. guess that's And in my view of my experience people in the way they That they pronounce it like ⁓ I would love you to do something that takes away all my problems But the second thing is they say and I know it's not possible

So I rarely get someone to see that is is very strong in their beliefs, like you have to fix me. And that's what it has to be. And I don't give a shit about how you're going to do it. It may have, well, maybe that's my context of work where I saw, okay, I see people generally who have been struggling for a while. So they have gone through ⁓ hope and disaster for the years sometimes.

and, ⁓ but, ⁓ honestly, ⁓ I think, ⁓ it's a right to, ⁓ like if there's a quick fix, you give, well, you should allow people to think or hope for it. ⁓ it probably, it's also something that brings the person to you. And, ⁓ and there's a difference between what you wish.

Tim Beames (03:20)
Hmm.

Bart Van Buchem (03:27)
how it would be, because if I need extended surgery, I would love that to be a quick fix. But in the end, it's extensive surgery and it probably going to take some rehab afterwards. And I'm not going to feel very good after, where it's going to take some time, but I wish I could be quick. Just put me to sleep and wake me up when everything is cool again. So I don't think it's specifically to chronic pain. I think it's widely...

understandable thing we as a human that we prefer quick.

Tim Beames (04:03)
Yeah, yeah. As you're saying that, sorry, I'm going to jump in, but as you're saying that I'm thinking about, and like when a famous sports person goes and has surgery and the reporting is, you know, everything went really well, you know, they've sorted the problem in the surgery, but there's still, as you say, you know, there's still recovery from surgery and rehabilitation back into your sport as well. So that's, there isn't, you know, although, although if you want, the problem might be

Bart Van Buchem (04:28)
There is.

Tim Beames (04:32)
in some ways rectified, there's still a long way to go in terms of resolution and recovery.

Bart Van Buchem (04:35)
Hmm.

Yeah. Yeah. So I think if people are sort of referring to something that the other, the other guy, the sports person is, has had this quick fix, but it is, I think it's another debate on what is it, what's the definition of a quick fix? Is that, is that someone else is solving your problem? Or is it that it is probably not going to be too much effort or uncomfortable?

Or it's just a wish for, just, I don't want this life. I just want to move on and take back, take back control.

But like I said, I rarely get someone to see who is really strong in their beliefs that it is literally a quick fix, like fixing your car repair or replacing the thing that is replacing the thing in your body to solve the problem. Because everyone would acknowledge, almost everyone, I guess, that it's probably not going to work like that because humans and bodies are

quite complex and interesting as well. and ⁓ again, it's a way of probably being quite explicit or ⁓ vocal about what you want, right? And I'm not sure how is your experience there to me, because you might see a different population ⁓ compared to mine, but

I can see that there might be differences as well.

Tim Beames (06:23)
Yeah, yeah, yeah, no, think, yeah, I think we're biased in a way, because people who I typically see have been experiencing problems for some time. There's still threat there, isn't there? The threat of what pain means to someone or threat of the impact on their life or work or ⁓ and you can understand why you want to remove that threat. ⁓ So, yeah, in a way that's you can.

You can understand it, absolutely. If it's possible, if it's available, then awesome. And I've massively softened from the messaging out there about making someone an autonomous part of the process, and empowering them. But to begin with actually just being able to check in and notice, if someone is seeking that...

quick fix, there's a message in there and actually being able to understand what that might be for that person I think is a good start in place.

Bart Van Buchem (07:30)
Totally. Yeah. Yeah. Yeah. That's what

the conversation, I think this definition of a quick fix, especially when someone is asking for something could use just do this to your, even if people are asking for a quick fix and being very specific about, you do this manip or could you prescribe me this drug? ⁓ even then

It's probably not because they would expect you to solve the whole problem, but there might be something more acute because tomorrow I have this wedding or tomorrow I have to do whatever to look after my kids. So there could be ways of reasons why they urgent people feel the urgency of I need something now. And don't get me wrong, because sometimes I think as a from a physiotherapy or well, even even like a medical

Tim Beames (08:15)
Yeah.

Bart Van Buchem (08:25)
field as well. I think we do have some quick fixes, which last probably don't last for long, but they might do the job for, let's say the 24 hour, whether it's going to be drugs or it's, it's, it's a specific treatment. If you think that could have short term, ⁓ short term relief, which could be probably be very helpful at some stage. So I'm not saying

We shouldn't do any type of ⁓ quick fixes at all, but it depends on the situation. ⁓ As well as that is probably communicated that is probably not going to solve the whole thing, but it's only a temporarily thing, which is fine. think that I be feel totally comfortable with delivering that type of care at certain circumstances.

Tim Beames (09:12)
Yeah, yeah.

I totally agree. Yeah. then that might be a beautiful window of opportunity that says, look, this is changeable. We can work with this. You've got some control in it or whatever that might be. So yeah, I agree with you. I'm not a sort of black and white. You must not do anything passive because actually there's merit to that as well. Okay. So let's just move on a little bit. So we've sort of...

getting to understand and in a way sort of position ourselves in why someone might look for or want a quick fix. In terms of you working with that, so what are the key sort of, ⁓ if you want ⁓ communication strategies that you start utilizing when you realize someone's coming to you and they want that quick fix then?

Bart Van Buchem (10:17)
Yeah. So probably that that's where I think quick fix as in, some degree, it's become not just, it probably is the way it's presented. Then we, and it's, our conclusion from a therapeutic approach of therapeutic, ⁓ perspective that we think, that's, that's, ⁓ a quick fix, that you are asking for. ⁓ but for the person, it may, maybe

just what they desire. ⁓ I think so step one probably is trying to figure out where this desire comes from. And ⁓ I can be quite straightforward, maybe a little bit Dutch in that perspective and say, well, why not tomorrow? Why now? ⁓

I think depending on your relationship with this person, you can think of how you're going to describe, how you're going to discuss this. Right. And, but the first thing is trying to figure out where this desire comes from. And it could be whatever. And I can see people like, I'm done. I'm fed up with it. I'm totally fed up with it. And I want a solution right now, which probably tells me, all right, so can see what's going on. So.

What does make you that it's today? So what happened? So many people sometimes, and then in this conversation, you will figure out then there is a context, there is a reason for, and it's not just that moment. But it's also very important, I guess, when you already have a relationship and people keep asking for a quick fix and you probably have to figure out what's going on with expectations. So.

You probably currently, yeah, you obviously didn't sort of had found a way to, to meet your expectations of the therapeutic, let's say potential results and how to evaluate that. I think from, let's say, let's say old school CBT, that there has been a movement that said, don't pay attention to the pain. Don't even ask for it. Ask for activities.

I think that could be also, that will be the elephant in a room. And I've seen many therapists struggling with that, but only asking for the pain probably is not also not the way to go. So from a communicative perspective and psychology, you have to dig a bit deeper in the reason why. And once that's sort of cleared up, you can decide and have a shared decision making process where you can see, right, so what is what we can and what we can't do.

So I think that's sort of putting, not putting you in the, that they would expect you to use a magic wand. ⁓ I think it's, they were checking in with you, what you actually can do. And maybe at that stage, they need to calm down first and probably calming down that requires more than just a few words. So you could probably have some interventions that help people to come down and then.

figuring out how to, what to do next. And I think it's in my clinic at Puppetable People, when they suddenly require a quick fix, usually that's like a panic. There's something, acute coming, it's something happened that requires urgent need of relief, which we can, obviously is we can discuss that and how to figure out how to meet that expectation.

Tim Beames (13:48)
Mmm, yep.

Bart Van Buchem (14:04)
Because I think people would be very, and that's my experience as well. They are very happy to sort of shape or sort of challenge that expectation and feeling relieved because the problem was maybe not as big as they thought it would have been. Just to give it some, some different perspectives. So, so I think that would be all about reframing. It's about understanding. It's about understanding the context.

of the patient and then you can move on from there. And it's probably easier to know what to do if you have this clear understanding of the reason why the quick fix is required at that stage.

Tim Beames (14:48)
Yeah,

need and the urgency behind it. Absolutely. Yeah. Yeah. So I'm hearing within that there's an element of listening, building trust, validating experience, sort of really truly being open to hearing what that person has to say as well. Yeah.

Bart Van Buchem (14:53)
Absolutely. Yeah. Yeah.

Yeah. And there could

be a social cultural part as well. So it could be the, the, the partner said, well, you've gone, you've seen this physiotherapist for like five times now. When is it, when do you start, when do you stop moaning about your back pain? So it could not necessarily, it doesn't have necessarily have to be the patient itself, but it could be their environment is, is, is expecting something to happen. I think that's also.

part of the system that you probably have to at least you have to take in account as a part of the conversation or what's going on, why it's there. And sometimes, yeah, having that as a intervention as well, you could say, to see that these expectations probably can be very destructive ⁓ or disruptive through the therapeutic sessions or the approach if

instant recovery is not happening.

Tim Beames (16:11)
Yeah, do you know just as you're saying these things I'm just reminded of a of a conversation with a patient I had very recently and they At the beginning of the session there was very much I want you to get rid of I want to get rid of this pain I don't think it was put on me, but it was you know there was I just want to get rid of this pain and then near the end of the session they reflected back and said

I think it was sort of really wise reflection actually, which struck me because they said at the beginning of the session, I said, I just want to get rid of this pain, but now I'm realising that it's much more than that. And in fact, if I reflect now, I want to be strong to be able to play with my children again. So it was a really interesting sort of reflect back.

Bart Van Buchem (17:04)
Hmm.

Tim Beames (17:09)
You you have this initial, I just want to be fixed, but then you start to hear coming out in the need and absolutely that makes so much sense, doesn't it?

Bart Van Buchem (17:22)
Yeah, or

finding a way of ⁓ finding relief or seeking relief is there is a merit in like if the pain eases or you have a relief of pain, you probably will have a much better function like that. That's very likely. But from a treatment point of view, probably would expect, well, what's the worst thing you can have? What happened? And it's probably you lost life. You lost...

⁓ reasons for what would, like you said, I want to play or I want to get back to the playing fields or I want to, I want to spend time with my friends and being more happy about what's going on. So that's the worries obviously. And then, and, and I think the solution probably sits where you can have at least some sense of agency and control over your, your bodily functions again, but also like you said,

Many people feel like I can't change the pain, but you can change the way your strategies and how you cope through. And in the end, and I think that's something that probably quite instrumental that there's a, there's a, it's very likely that pain would have a very different experience, could be very different experience when people don't feel the urgency necessarily, or they don't necessarily are in panic.

⁓ I, I use sometimes to use the metaphor. If you have your green glasses on, you probably wouldn't have exactly the same, let's say bodily experience, but it's in the way how you perceive it. Maybe you say, I can handle this. Right. And I can do the things that I like to do. But if you're wearing these dark glasses, these red dark glasses, it would feel really different and you don't feel the.

the resilience that you need to cope with it, especially when it's on a short term, because it's not so likely that it's going to shift, especially when people are having suffering chronic pain for years. Why would it just disappear at some point? But people do experience waves of inactivity, but also in quality of life and also in their experience of pain. So I find it really interesting how you

shifted instead of getting rid of the pain. Is there another way? Is there another way of doing that? Right? Is there a way of taking off these glasses, these dark bloody glasses and now get into the, let's say, is there a different color available that could help you to find back your resilience? And so that there are ways of reframing and therefore finding new strategies that actually

can happen in the clinic. And I think that's the next part we should talk about. So what is it actually what you're going to do in the clinic to make that work? Because I'm pretty comfortable to say that it's probably not going to happen overnight, but it's not necessarily going to happen through cognitive instructive therapy. I think you have to do something, you have to build trust in that way.

Tim Beames (20:28)
Yeah.

Yeah, yeah.

I agree. Yeah, yeah, yeah. So let's just sort of summarizing a little bit of what I'm hearing there, because you're sort of dropping in, I think, to the sort of perceptual phenomena of pain or the experience of pain. And as I'm hearing it, and I'm in tune with this, is that we have control over our actions, putting on a pair of...

Bart Van Buchem (20:57)
Hmm.

Tim Beames (21:08)
red glasses versus a pair of green glasses. I mean, but we don't have the control of the outcome of those actions. it's just that you are offering an opportunity to experience the world in a different way. And that might mean that there is a shift and a change in the experience, including of pain. So, yeah, like you say, let's sort of lead on to that next point, which is taking that

action, the first step. So someone comes with ⁓ urgency, their distress, their suffering, maybe even within the meaning of pain, there's something potentially quite harmful and troubling going on there. We sit with them, we meet them, we make sense of that together, we validate the experience, we build some trust.

We talk about expectations, then what? And then, and that sounds like we're at that next stage, which is the then what, you know, what, what do we do at that point?

Bart Van Buchem (22:21)
Yeah, it depends, right? ⁓ What are you might reflect on this as well, but there could be zillions of numerous ⁓ examples here. But let's say that things you can control, I would say things like you can control movement strategy of movement, you can, you can see if even if breathing is an opportunity.

but also reducing the threat value. So there could be this cognitive, I can't do this. Well, let's figure out a way how you can. And if you're worried about something that could be like, ⁓ shit, think my back is broken or whatever, something happens. I think my ear got this herniated disc right now. So we can actually check it out, right? So even running a physical examination could be a way of reducing the threat and then exposing people to

the movement they probably were trying to avoid or were avoiding and then using that experience and see what's happening and you can calm down right now. So you can actually before. So once they come in, they came in and they are, I'm, I'm buggered. Right. And then they leave the clinic. said, actually I can do much more than I thought. And there are other ways of doing it or understanding what you need to do. Right. So there could be strategies that

tell you, how do you, if you have a massive flare up, instead of instructing someone what to do at home. So let's do it Let's do this type of exercise. This could be any kind of relaxation or even movement. think you repeating the exercises you have considered to be useful as a, let's say de-threatening or like relaxing or calming or pain reducing type of exercises.

You can see how you can do it together. Right. And if people can treat themselves, for example, you can get strategies that could help positions that actually help you to find a moment that actually doesn't improve or increases the pain. If it comes to back pain, one of these postures that generally do very well is lying on your back with a comfortable pillow and with an extra pillow under your

legs, right? So you're in a 90 degree angle with the knees. And that somehow sort of gives people some time to slowing down and you can see if you can guide people through them. People in pain barely do that. Finding a position that actually brings the pain down to like zero or very little. That will be

And that's part of that control. you have an option to, well, depending on what kind of language you use, but if metaphorically that can turn off your alarm system or that could ease your system or that could basically give you control over your experience by reducing the load massively. And then you can basically can start building up again.

from there on instead of pushing, pushing, pushing until you drop and taking some meds and then moving on. So I think I just brought up a few options, right? So I think it's taking some control here.

Tim Beames (25:50)
Hmm.

Yeah, so let's,

yeah, yeah, that's what I'm hearing. So let me just sort of do my best to summarize there. So we've got in the moment, some, I would say little experiments, that's how I would see them, but we've got ways of actively engaging in a behavior, in this case, perhaps finding a posture, a position of comfort and ease. And within that,

building the experience of some relative control. So feeding back to the original question, which was, you know, people come with this ⁓ need for a quick fix, ⁓ then we are actually meeting them at a need as well there, aren't we? That if we have the ability to create the condition where something feels different,

relatively quickly. So if it's sort of in a two or three, four minutes or something of running this experiment, then we're feeding back into them the notion that they have some control where something probably felt out of control before that and maybe was part of that need and urgency and distress that fed that thought in the first place. Am I right in sort of summarizing it in that way?

Bart Van Buchem (27:22)
Totally, totally. Yeah. And the whole narrative. so gaining control and sometimes people need some external, let's say help, if you like, there's nothing wrong with like support at some stage when you're totally like, I can only relate to my mind to myself when I'm totally fed up with something. Sometimes I need someone to

help me out, right? To give you that perspective or giving that like, just listening, you just need to ramble a bit and then you feel much better afterwards. So this is what patients happens too. So instead of telling them they'd have to take control, you could also help them to give that feeling of control at least for a bit. And I could be a part of that control at that stage. And I don't think there's anything wrong with that, allowing yourself

to do some touch and some, and even if you do a man up and people feel like, that's something I might need. So that could be, I think there are reasons why you could do that, even though you might not fully, we don't fully understand how a man up could lead to pain reduction, or even if it will be a massage could be things of doing, I think it's like a, like a care.

you take at that stage and it doesn't gonna... but I don't and I think that's probably one of those things. It shouldn't be the thing you do over and over over again. So probably it's gonna... if you stick with the quick fix or you stick with... clearly and apparently the therapeutic process has somehow got blocked or stopped.

Tim Beames (29:17)
Yeah.

Bart Van Buchem (29:19)
you're

not going to move forward. And I think that's, that's something you have to sort of be, be careful about. ⁓ because if you not, if you can't move on, there's, there must be a reason for you why you can't. So that's another, that's probably another conversation. how are you going to cope when people still in this need of quick fix or relief and, and in, in it somehow doesn't, it, it, it probably

Tim Beames (29:40)
Absolutely.

Bart Van Buchem (29:49)
prevents you to move on in your therapy.

Tim Beames (29:51)
Yeah, yeah, yeah, yeah, you beat me to it, because I was going to say, you know, we've got and it sounds like this simple sort of flow that someone comes in and you build this nice relationship and they feel comfortable with you, etc, etc. And you run an experiment and it's successful. But the chances are we're going to meet people where this doesn't happen and they're going to clash. Yeah.

Bart Van Buchem (30:14)
Yeah, or occasionally, right? So they may do well for a

while, but they just come back.

Tim Beames (30:18)
And they go, look, I've done it all. It's still not working. You know, can you, you know, just, I just want you to fix it. And so what, like, let's just spend a couple of minutes just thinking of, of, and I would say these are super challenging situations as well, aren't they? So, you know, how are you working with those? And I mean, challenging, not that that person is deliberately being challenging to you, but, they are.

Bart Van Buchem (30:23)
Yeah.

Tim Beames (30:47)
they are difficult for us to work with, they? When you're doing your best, you've tried, you know, what you think is an effective and appropriate ⁓ treatment approach, but still you're met with that resistance.

Bart Van Buchem (31:05)
Absolutely. Yeah, you can't. Well, I think this is part of the, let's say, pain treatment, you, you could schedule like a whole series of, of, of sessions that and ask GPT to give you the full like detailed plan planning of your sessions, but life will kick in because it's not going to work like that.

Sometimes it's good to have this, this, well, let's say that this schedule, if you, because you want to tick some boxes, right? So you probably want to get to some, let's say, ⁓ you need to tick the boxes of like relaxing or let's say relaxation, exercise, sleep, dietary things that probably needs to be part of your therapy at some point. But I think you have to be very flexible in how things are.

⁓ evolving over the time and some things need more time and and then at the same time you're trying to keep track on the on the on the full skill I can see there will be if you're working in a pain clinic you got 12 weeks and you have to squeeze squeeze it in now you have to squeeze in everything this is one of the reasons why people sometimes drop off right so they don't go through the

full program because they have this flare up and it takes too long and they're not able to maintain the therapy or maintain the therapeutic process. So I guess that that's where it can be very challenging. It's hard to predict as well. But probably then, yeah.

Tim Beames (32:48)
Yeah. Yeah.

Bart Van Buchem (32:54)
I think I have the privilege that I can sort of figure out how we can sort of, if it doesn't work today, we can postpone for next week to next week. So that's a, I think that's a flexibility that's very helpful in the work I do.

Tim Beames (33:04)
Yeah.

Yeah.

But then, yeah, but then you are think you probably set up a condition where that person is willing to, to, you know, sit with things for another week as well. I'm just going to chime in here. And sadly, we're running out of time, but we will come across, will come across really challenging moments in our careers and, and, and that person feels so desperate and, and

Bart Van Buchem (33:26)
Yeah, as always.

Tim Beames (33:39)
Yeah, and you are desperate to be able to offer help as well. And that there is super, super challenging. ⁓ Sticking with it, know, validating how frustrating it must be, scary it must be, et cetera, et cetera. And sitting with them through those moments, it's really, you know, that really is, it's hard work, but it's well worth it. And my experience has been

those challenging conversations, if you can maintain that rapport and the relationship and you've built some trust and some safety within that, then as those moments sort of settle down, a sort of element of ease comes in and that person can come back and engage back in with the process that we are offering. ⁓

Bart Van Buchem (34:20)
Hmm.

Yeah, yeah.

Tim Beames (34:36)
It

can happen, but you will come across those difficult moments. I always used to think of them as squeaky bum time. You know, you're going, oh, I don't know whether I want to deal with this, but you know, that's it is just a part of that. you can't work. Yeah. And that person, if you try and sort of see it through their lens, they are scared. And how would you be if you were scared?

Bart Van Buchem (34:49)
You don't have to activate.

It's hard work. Yeah.

Tim Beames (35:07)
So.

Bart Van Buchem (35:08)
Absolutely. Yeah, that's I think that's well said, Tim. And ⁓ when things don't go following the plan. ⁓ Well, I think that will be our our probably that will be the way we probably should think about planning therapy, then then you have to you need this thorough, let's say, scheduled things that you need to tick off.

Tim Beames (35:17)
Yeah.

Bart Van Buchem (35:37)
in the back of your mind, but don't expect it to be happening exactly. So this as you would have planned. so even if it is this bum squeezing moments are there, it shouldn't surprise you. And I don't think you, if you're not following the plan exactly as it was, probably it's gonna not gonna dilute your effect. It's not gonna be a problem because at that stage is relevant.

Tim Beames (35:47)
Yeah.

Bart Van Buchem (36:03)
whatever you do and probably have to listen carefully what's necessarily or what would probably what you need to do or what you can do at that stage. So probably more helpful than stick to the plan and say, well, I don't have time for this. I hear you have slept very bad and was terrible, but now we're going to talk about food and dietary. That's probably not going to work out well. So I think this flexibility also goes with probably better results because you can, can sort of.

Tim Beames (36:23)
Yeah.

Bart Van Buchem (36:32)
⁓ shape it more to the expectations that are happening at that. So you know it's less confronting in a way and it's probably not ⁓ I think also like bending with your patient bit but also bending back right so you have to bend instead of break it. I think that's could be a nice way of doing

Tim Beames (36:48)
Yeah.

Yeah, yeah, yeah. Be bendable. We had that expression sometimes use it as being a chameleon. So, you know, you change a colour, you think dependent on the need at that time. But we've run out of time. So I'm going to do my best to summarise. We started with the navigating difficult conversations. So what happens when someone wants a quick fix?

Bart Van Buchem (37:00)
Yeah.

Tim Beames (37:21)
really challenging at times, but first of all, we talked about just understanding the urgency around that and why is it that that person wants a quick fix, pain and the meaning behind it, et cetera, what is stopping you from doing, you can understand that people wanna get rid of that. It's not pleasant, that's probably the main thing about.

like it's amazing at doing its job in a way, isn't it? Of being uncomfortable and distressing and making you want to change what you're doing. We talked about then obviously the building your understanding and knowledge around that, their expectations of what that means, some strategies about building some trust and...

validating the experience, et cetera. And then what we actually dropped into was the in the moment experiments of being able to empower someone with strategies that offer an opportunity to notice difference and change. And I think that feeds really nicely back into when someone doesn't see hope and that things aren't changing and they just want that one thing, the magic bullet, et cetera.

being able to work with and offer them strategies, you might not find it straight away. You mentioned about even a sort of resting posture for back pain. It might be just working with breath. It might be, you mentioned about the green glasses and the red glasses. So literally the way that you view the world might offer the chance that the experience of it changes. And there are times when things...

Don't go as you wished and that person, they persist in that need to change and perhaps there are confronting times where they're saying, know, yeah, we've tried it, but things still aren't changing. You know, I just need a quick fix. I'm gonna go and get surgery or I'm gonna get a whatever. I think of so many different times when people are, and you feel a bit deflated in those moments, but you can also understand.

and being able to engage with those people when it is confronting is a real skill. It can be hard work as well, but also what we've seen is it can be really, really deeply ⁓ meaningful and helpful in the long run to be able to stick with them. So I think we've done that. So Bart, thanks so much. And everybody who's listening got to this point. Thank you so much for.

Tuning in, we really, really value you being with us. And if you can let people know that we're here, share it, like it. We'd love to hear how you use these podcasts as well. We've had a bit of feedback from people, just stimulating conversation in the clinic and being able to use us as a little bit of a sort of part of your team as well, if you're working alone or in small teams or...

Feel like you're working alone because people are working in such different ways to you. We love to hear from you. So thank you so much for ⁓ sticking with us and wishing you all the very best.

Bart Van Buchem (40:48)
Thank you.