 Hello, everybody. I'm Mel Hauser. I use she they pronouns and I am executive director of all brains belong Vermont. Welcome to brain club. Let's turn on our backup recording. No, recording in progress. Alright, let me share screen and I'll get us oriented. So tonight we will be continuing our conversation on the double empathy problem this time in health care. So, and if that's a new term for you, don't worry, we will we're going to we're going to recap what last week was about and then we'll build from there. But first, just by way of introduction brain club is our intentionally created education space for our collective offerings belong community for purposes of educating about neurodiversity and topics related to inclusive community. I just just to name that this is for education purposes only. This is not a support group and this is not for medical or mental health advice. We have other programs for those things but this is an education program. 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And if you don't try the more dot dot dot and choose show subtitles. And if you want to turn them off do the same thing and choose heads up titles. And that is my visual support to open up the chat so if people are using it. I'll be able to see it. Okay. So as I said, this month at brain club we are discussing the double empathy problem my I'm doing something funny with my screen there we go. Um, so last week, we discussed perspective taking in relationships and some of the challenges there within. Today we'll be talking about a different type of relationship a relationship between clinician and patient. What's the double empathy problem double empathy problem is a term coined by Dr Damian Milton who's an autistic social scientist in the UK. Over a decade now, there's been consistent research that supports the double empathy problem which is, there is not one normal set of social skills and then the autistic people over there who don't have the social skills. It's that when there is a mixed neuro type, when there's a mismatch between communication style between worldviews, that's where communication breakdowns happen. So in Dr Milton's original studies, looking at autistic people communicating with one another, and not autistic people communicating with one another, and turns out that both groups struggled to be able to communicate. And then there was that mismatch of communication style and worldview. So what's the consequences this when it when it relates to health care. You know this data is about autism but this is not specific to autism. This applies to a much broader audience. What we know is that autistic adults have a very difficult time accessing health care. 80% of autistic adults have difficulty accessing primary care amongst people who already have a primary care practice like it's not like they're trying to find people who take new patients it's like, I have a practice but I can't access the care. 80% of autistic adults, and not surprisingly, high rates, 63 to 69% untreated health conditions in access health care, of course you're going to have more untreated health conditions. And only about a third of autistic adults report having a good relationship with a primary care physician, despite more than 70% of the same people thinking that it would be important to have a good relationship with a primary care physician. And more than a third of autistic adults don't even tell their primary care physician that they're autistic because of fear of judgment. What we know is that the barriers to care are extensive. So, we're going to be talking about the provider related barriers today, but everything's all connected. So in the environment, you know that the aspects of the interaction related to sensory processing communication, the systemic barriers, you know there's so many defaults in the health care system, you must pick up the phone to become a new patient. You must fill out the 20 page packet. You must fit into the boxes. You must show up in the 15 minute visit and somehow convey really complex things going within your body. It's not just autistic people. The health care system doesn't work for a lot of people. And in the study of autistic adults, there is a widespread experience perceiving that health care providers have insufficient knowledge and skills and unhelpful attitudes as an independent barrier to health care access. Training is not very good. So this is a study from Zerbo et al. in 2015. It's one of my favorite studies and by favorite, I mean that like fairly sarcastically. This is a study of primary care physicians. Less than 10% of primary care physicians would suspect that their patient were autistic. If they volunteer information, shows interest in people, discusses emotions and can see the whole picture. So that's what's out there. And I think that while in 2023, it's very encouraging that we have many clinicians that have been accessing health care trainings from all breeds belong for example, there's lots of people who are really engaged and looking to learn new things. And this was not part of original medical education for a lot of clinicians. And when you're only trained in stereotypes, that's what you see when you're out there in the world. Unless you're prepared to do a lot of learning and relearning. And that tunnel vision, that really narrow look at autism at even like, you know, the underlying physiology that autistic and ADHD people have like there's just so much tunnel vision so much fragmentation in the health care system. It really, it's like I like I like to say it's like Google maps when you're so zoomed in you don't know what continent you're on when you zoom way out and you recognize that everything's connected to everything. And what we know is that neurodivergent people have a pattern a pattern of intertwined medical conditions. And that next week, that's what that's what we'll be discussing it next week's brain club it's we're still calling it brain club but it's actually a it's it's not going to be a typical brain club. It's going to be a, there you go. It's going to be a, I would expect a larger audience than our typical brain club it'll be more webinar style, you know, maybe some time for conversation but mostly mostly a one way more of a one way type presentation on this process, which is the pattern of intertwined medical conditions that autistic and ADHD people very very commonly experienced. I made a slide about that. So yes so if you're not signed up for that already Lizzie can you drop in the chat. It's free just like any other brain club. If you're if you're not signed up already we would love for you to join us next week for our webinar about this process that is not part of standard medical education. So, you know, at all brains belong, we know that everything's connected to everything. And as we have been reimagining health care through community connection that it's that that that health and health care is not just medical care. It's addressing social isolation. It's supporting employment. It's about training the wider community health care providers employers you know like trying to make the environment actually meet people's access needs that's part of health to and when we think about the systemic barriers that the war neurodivergent people because of unmet access needs health care medical care. There's a lot of that. And so we're going to play a video. It's about 30 minutes where the clinicians at all brains belong we recorded ourselves having a conversation about our own learning and on learning process, how we as professionals have been navigating this journey of dealing with the system with the health care system barriers on learning some of our medical education and applying what we learn from our community toward providing health care for patients. So with that, David, take it away. The theme of the month is neurodivergent health. You know, as, as, as, I think we should, I think, I think we should share with our audience that, you know, not all our patients are neurodivergent. And certainly not all our patients I would identify as being an early virgin. And they come because their needs were not met by the traditional health care system. That's what they have in common. That's what they all have in common. And amongst that group, the overwhelming majority of our patients have this pattern right of neuroimmune conditions. I think they most often talk about not feeling listened to or heard. And I know that's kind of a vague saying, but I think being feeling like they're having their symptoms dismissed, whether that's because, oh, you're young and no, you shouldn't, you can't be in that much pain, you can't have this thing or Oh, this disorder so rare you couldn't have it. I was talking to another provider about, you know, neurodivergent health care and how common how some medical conditions tend to coexist, and that there's like actual literature and papers out there about it. And this is someone who's probably like five to 10 years my senior, like, they've been in practice that much longer than me, and they had no idea. And I didn't know that, you know, these things happen together. And so I think the issue is that these things are not on people's radar that because it's not being taught. Let's start there. So what do what do you remember. If anything about what you were taught about autism and ADHD. Nothing. I had no idea they could coexist. Yeah, I was never taught that they could coexist, despite, they almost like they coexist more often than they don't. Right. Yeah, I feel like for me, autism education was like developmental milestones and m chat and that type of stuff for kids. And then ADHD was this happens in kids and we use stimulants to treat it. And then, yeah, they were very, they were separate. I was not taught that autistic physiology was different than non autistic people's physiology. Like, I was taught I mean like so I mean there was there there was like so, you know, the deficit based paradigm of like you know here are the things that are wrong. And we call this autism in kids there was never a discussion about autistic adults. And so, like, I don't think that I had any ideas about autistic adults despite being one and not knowing, but like, I, like, it was just never on the radar that like there were autistic adults let alone the medical conditions that people have so like when the list of all the conditions, these are all things that kids had. There was also like, you know, the the the medical conditions that all the autistic kids had. They were it was very strongly implied, if not explicitly taught to me that there was it was like patient blaming, you know, like you have gastrointestinal things because you don't eat chicken nuggets and pasta, and you don't exercise so that's why you're constipated, like not that you have stretchy colons that get all get all stretched out. Right, per increased periodontal disease because of not doing oral hygiene. Right, right, right. I mean, and this is this is more systemic right in the in the healthcare system but the zoomed in style of teaching like, you know, there's psychology psychiatry and there's gastroenterology and there are all these things that are separated, but in reality, there are so many things that are interconnected that it's, it's a silly that we're not taught more of a like zoomed out picture this is like an entire being that is has multiple systems that actually work together and rely on each other and are influenced by like, how your DNA is being transcribed and it's it's just, it's unfortunate that that zoomed out more of that zoomed out approach to teaching medicine isn't taught because it results in the, in the zoomed in, like looking at these two things that you already know coexist and not seeing the bigger connections with some of these other things and how you know, how that impacts people in the healthcare system impacts patients in particular. Yes. And I think that what you said is really interesting because I think that I would describe my medical education as being very top down an autistic patient is more likely to have x, y and z list of conditions top down you memorize the associations and they're tested on board exams. But that's not how the patient comes in the patient comes in bottom up and in a healthcare system that is so fragmented like you said the opportunity, the pattern is not created in a zoomed out enough approach the pattern is created with way to and even, even people with the type of brains that are really good at pattern matching the, the, the, the, the whole picture of the pattern was not taught. And one of the reasons it's not is that these patients are thought to be rare. Right. So, so if, if what's described is that 2% of adults are autistic I mean, there's zero chance that that's true. There would need to be more than that. But anyway, it's thought to be, it's thought to be rare. So why would we make, why, why, why would medical education be structured on this entity that is, that is rare, because they're because what's missed is that the neuro immune conditions that are more common autistic and ADHD people are connected to the things that are known to be very common. So, you know, when we think about like in our practice right now, we see a lot of mass cell dysfunction and guess what that's kind of diabetes and hypertension and like all the things right so So in IBS and mood, anxiety, migraines, it's going to do everything, but yet, yeah, not soon enough to read. I think that's what primes primary care providers for doing this type of work is because, theoretically, they have the ones who are already doing that kind of like a look at the full body and the full patient and they're the ones who are seeing all the different things that are going on and know the patient longitudinally, longitudinally enough to theoretically be able to kind of see the connection between everything. But what I would say is that even though we have a population of clinicians who are ideally boys to spot the pattern. We have a medical system a health care system that is forwarding primary care clinicians to have full access to their cortex right like so we have this like this health care system that is forcing primary care clinicians to see you know a patient every 10 minutes. You know 1015 minutes and most practices are 15 minute visits for follow ups 30 minute visits for new patients, or you know, wellness exams or whatever. And on top of that, you're managing an electronic medical record system and paperwork and interpersonal work stuff it's like you have you have five, five or 10 jobs within one job already and so I don't want to there's no the blame is the system. I don't think that people go into medicine intentionally wanting to dismiss people at all, but it's just it's something that ends up happening you know you're exhausted you're tired you didn't eat breakfast you didn't have time to eat lunch, and then you're, and then you just you lose them. What's it called, you get dysregulated on. There's there's a line that that happens, and you're like backed up against the wall and feel like you, you know, in some some ways it may be the provider kind of advocating for their own access needs by saying okay we don't have time to talk about this today, but not knowing that that that's how that makes someone feel. You don't have the cognitive resources to do what needs doing in that moment because the system is sporting you. And so you, you're anyway you don't have the ability in that moment to zoom out because that's an executive function it's like a higher order brain skill to zoom out to self monitor to know like what you're saying how you're saying your tone your body language, all of this stuff. And I think that there's a lot of, you know, really inadvertent communication breakdowns that. Yeah, unintentional dismissiveness. Yeah. I think like what we what I hear a lot like we have new patients, you know, the overwhelming majority of our patients have this pattern right of neuroimmune conditions that that there is physiology that explains these multi organ system symptoms. People show up and they have like this laundry list of diagnoses and like, why would it make sense that a human being would have like 40 things wrong with them. Um, you know, turns out, you know, their connective tissue is different. Um, it's, it's just a different way of being wired and it just so happens that these physical health conditions which, you know, are are are are are exacerbated by dysregulation. And when your access needs are thwarted by like, you know, all of the systems. Um, this actually drives like a worsening of neuroimmune conditions. But people don't know that they just like feel broken and they're told that they are broken and they're like shamed for seeking help. So like, anyway, shame for seeking help, shamed for seeking help in the way that you authentically communicate when you seek help and shamed for not complying with recommendations that don't work for your brain. Right. And when we hear their story, they can trace this back for like decades, right? Like decades. Yeah. And it's about having the, the opportunity to share your story in the way that works for you. So some people need to info dump their story with math words. Some people need to bring a list. Right. They're the one that's like shamed and other by the health care system. That list is incredibly important because it has all the information in it. Like, anyway, there's some people like, you know, we have a patient who I'll never forget new patient visit, you know, brought a mind map that showed me like, you know, all the things that like, this makes it worse, this makes it better. And I'm like, I know that pattern. Right. So like, if you get the, you get the patient's information in like their, so to say, like, in their native tongue, like, in their, in a way that know that they best communicate, you get a ton more information. But the system works patients from communicating. So people come in, I think the other thing that I often see, especially with kids coming in with their different kids, especially is just that they have not been able to access pair in other settings. Just due to the like sensory overload of the specific setting. And so, you know, whether it's like providers not knowing their sensory needs beforehand before actually coming into the visit or like just before walking into the room. Whether it's like the fluorescent lights, whether it's thinking that they're going to need a vaccine the entire visit and being anxious and not interacting the entire visit until they know they don't need one at the end. And that's why I like having the like information before a visit of what somebody needs what their sensory needs are because starting off the visit that way makes such a huge difference and if we didn't have that I wouldn't know necessarily. Well, you lock something out. How do we have that information. We asked, right, like, like, that's, that's the thing right so if you ask people what makes them comfortable and you ask and you and like you try to do those things. They usually have a better healthcare experience. Right. Yeah. I mean, it's just, it's just the systems within the systems already have like, there's right there standard expectation like this is how you communicate. This is how you take information, like, you know, people, people teach you how to how to take notes, like when you're in school, here's how here's how you study something without ever knowing how your brain works. Like, and then you try to fit yourself and mold your brain and your weight, your whole way of being into the box that who knows who designed it, but the box that has become like the standard expectation of how to communicate, how to interact, how to socialize, how to just exist, how to be within the workplace. And, and it's, it's, it's suffocating. I mean, I remember even like as a premed student, like, you know, my volunteer gigs or like some of my jobs after college before medical school, like, it was just so clear that there was judgment going on. And that that what you just said, like, you know, that there's one right way to do the thing. There's won't be like, it was just so clear that it was not okay to show up as, as one's true self, not not just as as a professional like as a patient. Like, I remember being like a young 20 something and I remember being like, you know, oh, I have to do something I have to do something to make sure they don't think I'm weird, or that I'm like melodramatic or that you know anyway I have all the things I've all the things I've always had all the things. As a patient, I've never, you know, I've never had to care for my all the things because I never tell anyone why all the things because that's a surefire where to get judged. Not because it's funny, it's just, it's, it's, it's one of those just acting this way communicate in this way or you will go unheard. Yes, like you have to, you have to communicate a certain way or, or you, you won't be heard and not everybody can make that adjustment. And so those are the, those are the people that are staying away from healthcare because it's overwhelming or confusing or uncomfortable or unsafe to Yeah. Yeah, I feel like I see that so commonly, like, if, if I'm talking to somebody about like being in a pre diabetic range and before I even say anything they start with, but I eat well and I've been struggling with my weight and my entire life and like preface it with like I'm doing all the things. Please don't blame it on me being at fault or, or blame it on my weight. And it's just so ingrained in patients to kind of preface a visit with. These are all the things that I'm doing because otherwise it's so common for it to, because that's how we learn that's we learn that diabetes is lifestyle factor related and that's the only thing versus information and genetics and all the other things. And that sells to be to it. Right. Right. And that like weight isn't always totally changeable. It's also that, like, I mean, I mean, this is, this is like, such a bigger picture like so, not only is there a right way to be a person, but, but like the message that there's a right way to be healthy to and like so you know when you think about like all of the And it's like fat bias and shaming that goes on in the healthcare system and it starts in childhood and they just it's, it's so bad. I think shame, shame is unfortunately one of those, one of those things that is, I don't even know why either taught from the very beginning. You know, as children. I wish that it were normalized to say when you don't know. Instead, what is modeled or what was modeled for me as a trainee is that you fake it till you make it. And that when someone says a thing that doesn't match your worldview, you qualify them. Well, that's not a thing. I remember hearing in medical school. And thankfully I had a nutritional biochemistry background so they said that taking vitamins is just paying for really expensive P. And I was like, they were like, Well, why would they say that because they stopped taking the vitamins because they felt guilty and shame. And I was like, because they don't know biochemistry. They don't, they don't understand that nutritional needs of different humans are just as different as the brains that are operating. So instead of saying, I don't really understand how the human cell and mitochondria and all these different vitamins and minerals interact. So I'm going to say that taking vitamins is stupid you can get enough from what you eat. And, and then and then I'm going to teach that to people that are training under me who are then going to say these things to patients. And we all just don't know what we're talking about. I remember being taught that people who outgrow ADHD kids outgrow ADHD. And you know, I believe that I was taught it despite being an undiagnosed ADHD or like, anyway, that kind of mythology is just so widely held. Anyway, like I remember as a trainee, you know, the patient, the patient with the list. And like, I thought that was awesome. Some of the dual processor and I wanted to read the list. And, but anyway, that person gets shamed, but also like the patient that comes in and says, you know, I read about this on, you know, WebMD or some other website and like I read this article and I want you to like, you know, how does this fit into my, like, I don't know. I just always thought that was awesome. Because they like, they were engaged in their health. And anyway, it doesn't, it's, it's not that hard to be like, I don't know about this. Thanks for the article. I'll read it. We can talk about it again next time. It's not that hard. But that's not model. The office of that is model. But like in the context of what we talked about before, where the system is like, you know, you must see the patient every 10 to 15 minutes. Like, so now I have something else to do. Right. It's, it's, it's unfortunately, I think within the medical community, it's learned to behavior and learned to behavior from maybe, you know, someone else's teachings that the list is bad and those those patients are complicated, complicated and, you know, the eye rolling and all that kind of stuff. It's all, it's, it's learned. We weren't, we weren't taught how to, how to really manage that, you know, as a, you know, um, well, just see them more often. Right. Wow. Okay. Right. Right. It's that easy. It is that easy. And I think, like coming back to the, like, not feeling comfortable saying you don't know things like there's this expectation that a healthcare provider is a knows everything about every single body system and that's, that's not feasible for anybody, I think. I mean, I certainly don't know everything about every body system. Like, primary care is really hard. And right. Yeah. There's so much to know, there's so much to spot you're on the front lines, and then you have the system thwarting your ability to do what you're trying to do for your patients. Um, you don't have full access to your cortex, and you're trying to survive and like, it feels a lot like treading, you know, it's like treading water and like trying, trying to survive and trying to do everything you can for your patients. There's just, it's so much. Yeah. And I think for those in traditional primary care practices. Whether you're hospital owned or private, I mean, what's normalized is the dysfunction of the system. It's like, yep, this is just the way it is. So, you know, so that's what we have to do. So we're just going to keep doing it. And just felt like there has to be a better way to do this, but like everyone's stuck. It's a failure of imagination. Right. So like, what we do all day. I mean, the reason we're really able to do it is because we don't have a bureaucracy, like the patients need a thing and we kind of like try to figure out how to do that thing. Like a system, systems get dysfunctional. I mean, like I think individual providers are most frequently operating in systems where they don't have autonomy or agency to do all things like when I do trainings for like in services for healthcare practices, or even like it, you know, conferences, like people are like, Oh yeah, that's really great that you can do that thing in your in your special setting. But like, you know, us, us, us people in the trenches. You know, what, what, what, what about us? It'd be good to wrap up maybe talking about like, what are some things, not just like, you know, what are the medical conditions we manage and how do we manage them but like, what are some like, what are some things we do that are free to do that like, I don't know, are different than, than, than in other settings because I think that one of the things that we do is, I think we in we teach patients that they are the experts in their own bodies. Many of them don't know that this is like new information that they're getting that lens is really a requirement for for trusting your intuition for connecting all the dots for learning about your access needs and naming it when they're not met. If you don't think that you're the expert in your own self. Because you got messages to the contrary. Yeah. Yeah, that's definitely. Definitely makes a big difference. I think as a practice us, you know, before patients even come in, we're asking them before they even come our patient, they know that we care about how they learn information how they would like visits to go. Giving people choices of sensory needs and ways to access care and a lot of those are free like turning off the fluorescent lights in an office or letting people bring fidgets and whatever they want with them and making that explicit that like you can bring whatever you want with you. Having things in the office of people to be able to write their own notes so they don't have to bring their own things. I think we, we often get feedback right that patients have never been asked for what they need. But the fact that we asked means that we care and that makes that patient that much more comfortable to share things in their like authentic unique way. Right. And the fact that, you know, like, like you said before gave about how you know we were trained to ask questions a certain way. Like, this way, there are some brains who can't answer questions in the way that they're being asked in that default way. And so like just the idea of, you know, open-ended questions do not work for all brains and the idea of providing people with a menu for examples of like these are these are things we offer all people with all types of brains and you can let us know if any of these things would be helpful to you. And it's not because you have, you know, an issue you don't have a sensory issue or a communication issue. It's that you would just find these things helpful to have available to you. That's all. The other thing that I think that I've learned in this past year and a half is that like just the idea of healthcare as community. And I think, I think that has really, really stayed with me because I think, I think that's what I think that's one of the one of the key things that we're doing. I mean, like it's not for everybody. That's why we try to be really transparent about the model here and, you know, have people not, not join not come when they're not looking for this model. But remember at my, my old practice in a traditional setting, I remember meeting with people back to back who were had no friends, totally socially isolated. And it was like, they actually like loved the same things and like the healthcare system says that you, you know, HIPAA, you know, you can't do anyway. Well, it turns out like they can introduce themselves to one another if you build a forum that they would both come to. Think about how much we have learned from patients like coming as this as this as this village like when we think about like all these really complicated medical conditions that most of the healthcare system doesn't understand when you bring patients together and you give people an opportunity to describe in their own ways what their experiences like and what helps and does not help. People feel alone. They feel just alone in their lives. Was that the end David? Yeah, I showed the ending of it. That was the end. Yep. It seems anti-climactic. Anyway, who knows, I cut something off when I posted it or something. Anyway, thank you. So lots of really thoughtful comments in the chat all throughout and I really appreciate everybody engaging with this and sharing so many of their experiences. There's so much suffering out there in the world. There's so many people who feel invalidated, dismissed, misunderstood by the healthcare system. And, you know, it was our goal in creating that video to invite consideration of the healthcare system as a villain, not the individual clinician, because when we have a system that thwarts the clinician from having their own access needs met, how would they have access to their cortex to like do the hard work of zooming out, to do the hard work of perspective taking, do the hard work of adapting communication. It's like everything we talk about in brain club about what's hard for us to do when we don't have access to our cortex, at least not fully. And so, you know, I think that like we talk about so many different systems that are designed to perpetuate the systems that end up thwarting all the people in them. The healthcare system is a really good example of that. I wonder if anyone has thoughts about that? Have you ever thought about, for those who've had negative, negative is like, you know, understatement of century, negative healthcare experiences, you know, like, like, painful, harmful, like all the things, healthcare experiences. When viewed through the lens of the system, does that help, does that help your own narrative of what happened? Maybe not, but I'm just curious. You've got a thumbs up for Monique. No, how many. Hi, Amanda, cheer pronouns, and this is my first time though I've come across Mel Hauser and doing some other research stuff. Um, and I because I was in training, like MD PhD track before I got really sick and my slew of all the things. I had, I already knew the kind of grinding pace that especially for profit healthcare puts on providers. So yeah, it absolutely, it didn't make it any less hurtful, but the source of the pain was certainly shifted. It wasn't like, Oh, this specific provider doesn't like me or doesn't listen to me. It was easier to understand. I am one of 40 patients that this doctor has to see just today and that they are being evaluated, they are having their time limited. And so it was helpful in that I didn't take it as personally. But it also made it in some ways more painful because I was like, Well, if it were just an issue of getting this doctor to listen to me, then maybe if I switch doctors, it would be better or maybe if I find the right combinations of words, it'll be better. But the fact that it's just an crushing system makes it a lot harder to fight as a singular patient. So like, Well, actually now I need insurance to change their compensation structure and I need the department to change the RV use per provider. And I can't do that on my own. Amen to all of that. Thank you for sharing. You know, and I think that, you know, there's a lot of a lot of discussion around, you know, health care reform, as though like if reimbursement for things were adjusted, like that would make it all okay. Like it's, it's, it's so much, it's, it's such a big system. It's a big system that, you know, for, for, for, you know, all the like I think about like when I began my medical training, like I was so enamored of patient centeredness, the health care system can't possibly be patient centered. The health care system is, is, is oriented around how efficient, how, you know, an efficiency like, you know, any other kind of like factory work is its cookie cutter. And I don't think that's how health care has to be treating in the chat. Bruno says the health care workers are just as stuck in the system as we are as patients. But often I'm left confused not understanding and are traumatized and invalidated. Yeah, such a common sentiment. Yeah, and as Sierra says, it's not just the health care system to improve health, you have to improve everything else. You know, it all brains belong. It's, it's, it's, it's very common that our patients come in and are describing like what's going on at school, and what's going on at work. And like those environments are also forwarding people. And so like to improve health, we are also strategizing around improving their experiences in those places, because that's part of health. I wanted to say something about one thing I don't understand that still exists is the BMI. There was down a bit of a rabbit hole about where that came from. And it was a mathematician that dabbled in sociology that also believed in eugenics, and we still use it. Like, that there is no real medical basis to BMI and the numbers that this mathematician came up with. And that like I remember even like as a medical student actually like it probably hasn't a premed like, I remember like very early in my trajectory as a physician, like, this makes no sense. This is ridiculous. But I did not know the story about its origins and thank you for sharing that I think that's really important. It's kind of like how I don't know for those of you who were at our April webinar on the health care systems role in perpetuating the stigma of autism. I told the story of how autism made its way into the DSM. That's also not, that's also a story of really gross and horrible things. And like, these details are really important. And they're not known. Comments in the chat with, with, with more details on BMI. So it's originator interested in the systems of perfection, including the math of bodies and the orbits of planets. I don't know this story. That's so messed up. And Sarah's saying BMI is linked to shame for many like there's, you know, healthcare and shame. There's so much shame that people go through. And, and I think that, like we talk about with with so many other aspects of shame, where the power of naming the thing having someone else saying me to, and that that for so many people makes a difference because shame breeds in in isolation. And if you if a person has an experience of being shamed in the context of health care. Often people think they're the only ones, and they feel extra broken and defective and deficient and all of that. Now, hi everyone. I'm going to stick with my tradition of speaking up in these webinars. I am late fifties and just recently had was affirmed in my autism, even though I knew for this is a common story right that I knew longer. Anyways, I'm at the point of trying to unravel all the internalized. How I have in turn I ignore myself when I am ill or unwell, or a new symptom shows up or something quirky is going on with my body or I'm, I'm set in a way that isn't supporting me. I am at the stage of re parenting I don't know what the word is, deconditioning myself in the ways that I have been conditioned by the medical system and yeah it boy it's a lot of things huh. It's all the things and a lot of things, but I'm at that stage and then. Yeah, I got nothing else to say there. That's me. And, and so many people in our village are going through very similar processes. And you know I think that all brains belong. It, our staff our team is often reflecting on, you know, like I said, like systems drive systems. And, you know, we've, we've really been very intentional about doing it differently. We've all been in other types of healthcare environments and, you know, that doesn't work and didn't work for us didn't work for patients does. Anyway, so but but but when you are. When you are like, in, in what like, I don't know the word is you're like having to interact with these systemic structures that don't work. You can see how they're big and they're powerful and they like make you think you have to do things in certain ways, but you have to be really intentional about not doing and as independent practice that consisting of humans who have autonomy over our practice. Like you got to imagine that in an era where most healthcare is provided in hospital and systems, individual clinicians don't have that autonomy. So like we talk about so often at brain club autonomy is an access need for many people, but we've been, we've been really encouraged we've been encouraged that reimagining healthcare has in many ways like yeah healthcare is complicated. But it also doesn't need to be. So when we think about the premise of there's no right way to be a person, you offer everything you do in multiple different ways give people freedom and choice to pick what works for them. You name that people have been through a lot of bad past experiences and that you want to understand that. And you want to understand what stresses people out so that you don't do that. And you won't understand what makes me feel comfortable so that you can do those things on purpose. You don't have to be that complicated. Oh, and you connect people to other people, because social isolation is really bad for health. And so commonly, you know people come here because their needs were not met by the traditional healthcare system. And, you know, not only, you know, to maybe people find that they have all the things or maybe people find that they're neurodivergent. People find a community, they find other people who are going through they're going through, and they feel a lot less alone, a lot more hopeful. And so, with that, we're very excited next week, because not only will we be giving you a tour of the all the things project and the free resources on that site. And I know that if wherever you wherever you get your health care, these are resources that can help you advocate for your own health care. And, oh, thank you, Lizzie for popping out in the chat. And, you know, I think a lot of, you know, it's just a disclaimer, our team really wanted to, for those of you who are brain club regulars. This, this is not going to feel like brain club. This is going to feel like a completely separate thing, because there are 112 people registered so far. Who knows if people will come. But, you know, we think this is an opportunity to teach a lot of people about all the things because there's a lot of people who need to know about all the things. And if they are a clinician, they need to know about this. If they are patient, they need to know about this and how to bridge the double empathy problem to talk about this with a group of people who's being thwarted by the health care system, and yet has this enormous task of unlearning to do while trying to meet their own access needs and survive in the world. And we'll also be discussing a little bit more about our model of health care here at all brains belong and some practical aspects that like, aren't that hard, aren't that hard to carry out. So thank you. Thank you all so much for being here and being part of our community. We look forward to seeing you next week.