 Recording in progress everybody. Welcome. Welcome to brain club. It's nice to see so many returning folks and looks like folks who are here for their first brain club. So that's, that's awesome. So for those I don't know yet I'm Mel Hauser I use she they pronouns and I'm executive director here at our brains belong. Let me share screen and I'll get us oriented to brain club. So brain club is our weekly community conversation our community education series about everyday brand life. Every week we have a different topic and all oriented around a monthly theme. You know an education space created for the collective ABB community to educate the community about your diversity, because of the kind of the limitations in our capacity here, where it's a, you know, a mix of people who receive their medical care here and people who do not. We kind of create this we carve this out as an education space where it's not for medical and mental health advice and it's not a support group because we don't have for we don't, we don't have that kind of relationship with everyone who attends so it ends up not being safe to be you know processing individual trauma when when a person doesn't have follow up etc if they're not our patient. So that's that's that's that's what brain club is and is not and why all forms of communication are okay here all forms of participation are okay observation is a completely valid form of participation. But you can have your video on or off and even if it's on we don't expect anything of you we certainly don't expect you to look at the camera or sit still or anything so you know, please, please feel free to do what needs doing to digit stem eat take breaks. And you know everyone, everyone's welcome here at brain club, and when, when there are some particularly loaded topics like there will be tonight for the first part of brain club will get some content mornings on the topics in case there are some little years around. And as I said all forms of communication are okay. You know if it. We, we, we have a chat box going you're welcome to use it at all times part of brain club tonight will be a prerecorded panel interview set will have the chat box going through there and then we'll have plenty of time for discussion where you're welcome to communicate with mouth words or in the chat. And in addition to affirming all aspects of identity we really want to respect and protect the, you know the groups collective access needs, particularly as the size of brain club has grown. So our communications advisory council put together some communication ground rules that we use to respect and protect group access needs. As I said, you know there may be some little ears who may be listening off screen, particularly because there are a lot of folks who participate with their video off we just ask you to be mindful of your language and respect and give space for all participants to have space to share. Last bit of access related ground rules is just to orient you to close captioning. So, depending on your version of zoom to toggle on close captions you can choose either the lab transcript close captioning icon, or if you don't see that one try the more dot dot dot, and choose show subtitles. You could also choose hide subtitles if you want to turn them off. And fun. The chat window so while we have our particular mean at all times but particularly while we have our video playing will have the chat running will facilitated chat conversation. And that is the little speech bubble icon that's how you open the chat. So it is June, and we're kicking off our new theme of the month this month is all about neurodivergent health. And we've got, we've got a number of of important exciting topics this month on tonight we'll be talking about neurodivergent health challenges. So, I want to just give you some background information about neurodivergent health challenges. Before we launch into our pre recorded panel. So, I do need to give you a content warning for the next I'd say five minutes. I'm going to be talking about some terrifying health data to stress for which were deaf, including suicide and trauma and systemic ableism, because unfortunately, these are they're part of the status quo of neurodivergent health. So, I'm going to share some, some information about autistic health in particular, nearly 80% of autistic adults have difficulty accessing primary care. And not surprisingly, if you and this is again, and this research comes from people who have primary care physician relationships established like they have a practice they belong to, and 80% have difficulty accessing care from that practice. And so, not surprisingly, 63 to 69% of untreated health conditions. And despite 76% of autistic adults saying that having a good relationship with a PCP is important to them only about a third do have a good relationship. And more than a third don't even tell their primary care physicians that they're autistic specifically because of your judgment. And so, not surprisingly lower rates of access to preventive care. And the barriers to accessing care cluster around three buckets dirty at all in 2020 surveyed autistic adults and the barriers to accessing health care related to the environment, including like interactions with the environment, you know involving sensory processing communication. There's a system. There's so many defaults in the health care system, you must pick up the phone to make an appointment. You must fill out the 20 page packet to become a new patient. There are so many defaults that are a mismatch for not just autistic patients needs but lots of patients needs. This is the health care culture that in which health care providers I can say this because I am one where we're trained that there is one correct way to be a person, and that hidden curriculum for medical trainees along the way. This is what it looks like to be in pain. This is what it looks like when you know anyway there's all kinds of defaults. And autistic adults perceive that their health care providers have insufficient knowledge and skills to take care of them and harbor unhelpful attitudes. You know, these, these buckets, they apply to so many things, not just health care. And that's not why we're talking about this. We're talking about this, because autistic patients are dying. The average life expectancy for an autistic person is 36 to 54 years, not dying from autism, dying from premature cardiovascular disease and suicide. I'll come to the cardiovascular disease part which is not what we're going to share about autistic physiology also applies to the physiology known of ADHD years as well we'll get to that. The idea about suicide is that autistic adults have a four to nine times increased risk of suicide, and that that risk is higher in those with lower support needs. That is, those who are pressured to mask to hide their autistic traits that is associated with an increased risk of suicide and so it is my medical opinion that any interventions that are driving masking behavior are increasing the risk of suicide. And not only what when we think about the training that primary care clinicians typically receive in autism. It's stereotypes, it's stereotypes and so this study Zerbo et al in 2015 showed that less than 10% of PCPs would suspect that their patient is autistic if they volunteer information show interest in people discusses emotions and can see the whole picture. And, which is why it's not surprising that so many people make it to adulthood without understanding the way that their nervous system works. And it's not just that. It's that there are medical conditions that autistic and ADHD folks commonly have that are not part of most primary care clinicians trainings. Joint hyper mobility and related conditions. structural issues related to the way that the scholars shaped and the job of face, the teeth, the nervous system, autonomic or automatic nervous system functions sleep disorders migraine blood vessel differences. Fibromyalgia and other chronic pain conditions. These are really common in autistic and ADHD folks, and this is not well known or well understood by the healthcare system. So taking this list, showing you this list, specific to autism, but there's, you know, we think when I think about autism and ADHD I think about these as, you know, a huge, huge overlap, and so many, many of what I'm sharing. I would be. I do it even if the slide says autism. I'm going to say autism ADHD for a lot of these co-occurring conditions. So, you know, in medical school and residency, I was taught that these things commonly occur with autism. But I was, it was, it was never really wondered, like why turns out when you zoom way out. It's that connective tissue, and the nervous system and the immune system, all of this crosstalks through the whole body, which is why many autistic and ADHD folks have systemic health conditions. And when I shared with you the rates of premature cardiovascular disease, these things potentially are connected to that. What we know is that everything is connected to everything. And so, unfortunately, and one of our patients provided provided this analogy that I thought really, really worked before I should be unfortunately. And by the way, I'm done with my content warning about death and suicide. If a member of my team can type that in the chat, that would be amazing. In case folks opted out from that part. So, the idea of a ball of yard, if you pull the wrong string, you make the knot tighter. You have to find the right string to pull. Unfortunately, the healthcare system is all too often fragmented, all too often body parts are thought about as separate entities when really everything is connected to everything. And unfortunately, sometimes some of the standard management of some parts of these neuroimmune conditions that are more common neurodivergent people, sometimes the standard management of some parts, make the other parts worse. For example, if someone has chronic pain and they are prescribed a muscle relaxant, but they also have a sleep disorder like obstructive sleep apnea, and they also have underlying hypermobility where they have stretching connected tissue. Well, potentially that muscle relaxant made their stretching connected tissue stretchier and made their airway obstruction worse which made their dysautonomia worse which made their pain worse and it's just on and on and on. And so, when we launched all brains belong, you know, not only was it really clear to us that we needed to do anything for the neurodivergent community we have to do everything that it's not just medical care we're also looking at employment and education and social connection, but even within the, you know, the medical care bucket. There is a lot of unlearning and reimagining that has had to go into this. And what we have learned the most from is our patients in, you know, building this community village of learning and healing together. That is where I think the, the, the, the most, the most successful reimagining has come from that. And that's what I'm about to do before I launch into this conversation between me and my colleagues here at all brands belong Sierra Miller and gay porcella we recorded an interview last night about our experiences on navigating this doing the unlearning and reimagining. So what I'm going to just put forth is that we're we're intending this conversation to be addressing the double empathy problem, double empathy problem that you've not heard that expression before that's a term coined by Dr Damien Milton, who is an autistic social scientist in the UK, who found through research that it is not that there is one set of normal social skills. It is that when there is a mismatch between neuro type between autistic versus not autistic. Neuro types that mismatch of worldview mismatch of communication style, that is where communication breakdowns happen. So there, you know, the double empathy problem can be thought of in so many different ways and I think as it relates to the healthcare system. So I'm trying to bridge the double empathy problem between, you know what what what we know about neuro divergent health, and what we know about being trained in and having practiced for a long time in the traditional healthcare system, because I think that it's a there is communication between healthcare providers and patients so often because of the mismatch in communication styles and content. So with, with that, David, if you can queue up the video. We will start so this video is 29 minutes long. It was an hour and nine minutes originally so we worked really hard to get that get that paired down. And so, during, while the video is playing we'll have the chat going, and then we'll still have plenty of time for conversation to follow. Here we go. The theme of the month is neuro divergent 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 neuro divergent. And certainly not all our patients, I would identify as being a neuro divergent. And they come because their needs were not met by the traditional healthcare 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 neuro immune conditions. We most often talk about not feeling listened to or heard. And I know that's kind of a vague thing, 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. You know, all this disorder so where you couldn't have it. I was talking to another provider about, you know, neuro divergent healthcare and how common how some medical conditions tend to coexist, and that there's like actual literature and papers out there about it. 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. Like 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. Right, so 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. 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 mean, 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 that are wrong. And we call this autism in kids there's never a discussion about autistic adults. I don't know, like, I don't think that I had any ideas about autistic adults despite being one and not knowing. But like, I like, 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 co occurring conditions. These are all things that kids had. Um, 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. And this is, this is more systemic right in the, in the healthcare system, but the, the zoomed in style of teaching like, you know, there's psychologist 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. A holistic 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 And as 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. Because it's not known. And one of the reasons it's not is that these, 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. It 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 in 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 all this function 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 good to everything, but yet. Yeah. No, it's not enough to. I think that's what crimes primary care providers for doing this type of work is because. Theoretically, they're 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 healthcare system that is forcing. Primary care clinicians to see, you know, a patient every 10 minutes. You know, 10, 15 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 5, 5 or 10 jobs within 1 job already and so. Not, not, 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. 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 would I hear a lot like when 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 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. When, when, when we hear their story, they can trace this back for like decades right like decades. Yeah. Um, 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 mouth words. Some people need to bring a less. Right, right, right, right. They're the one that's like shamed and other by the healthcare 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 are 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 their way that know that they best communicate, you get a ton more information. But the system works patients from communicating. And 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, yeah, 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. If we didn't have that I wouldn't know necessarily. Well, you lost 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. 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 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 these the standard expectation of how, 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 pre med 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 was the wrong 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, all that I hope 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 always had all the things. As a patient, I've never, you know, I've never had care for my all the things because I never tell anyone why all the things because that's a surefire word to get judged. Not because it's funny, it's just, it's, it's, it's one of those, it's just acting this way communicate in this way or you will go unheard. Yes, 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. 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 lifestyle factor related and that's the only thing versus information and genetics and all the other things. And also, we know that it can be done on ourselves to do 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 of the anti-fat bias and shaming that goes on in the healthcare system. I mean, it starts in childhood. I mean, it's just, it's, it's so bad. Yeah, 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 quackify 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 pee. 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 of 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 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 quote, outgrow ADHD, kids outgrow ADHD. And I believe that I was taught it despite being an undiagnosed ADHD or like, anyway, that kind of mythology is just so widely held. It's the same way like I remember as a trainee, you know, the patient with the list. And like, I thought that was awesome. So a visual processor and I wanted to read the list. And um, 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, 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 opposite of that is, is, is, 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 behavior and learned behavior from maybe, you know, someone else's teachings that the list is bad and those, those patients are 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. 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. Primary care is really hard. 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, uh, 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 only 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. And 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 at, you know, conferences that 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 people in the trenches, you know, what about us? If we could 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 other settings? Because I think that one of the things that we do is I think 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 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, you're all huge. 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 often get feedback right that patients have never been asked for what they need. 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 you said before, Gabe, about how, you know, we were trained to ask questions a certain way. Like, guess what? 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 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 like we try to be really transparent about the model here and, you know, have people not join, not come when they're not looking for this model. But remember at 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 experience is like and what helps and does not help. People feel alone. They feel just alone in their lives. And once they know that they're not, there's so much healing in that. I would love to know what's, how, I mean, it's hard to say like, how did that like, and there were so many things that were part of that, but love to hear any responses or reactions or thoughts that anyone would like to share. Yeah, Steve, it's, that video is posted on our YouTube channel already. David, do you have the the URL you just played that you could post in the chat? Because the whole brain club will eventually be posted, but that video is already posted. Yeah, sure. Let me find the original YouTube because. Oh, you put it in something else. I downloaded the actual file. Here it is. Okay, hold on a second here. The theme of the month is neurodivergent. Awesome. Oh yeah, so Steve is reminding me of the new fact I just learned that people can't copy from the chat, but if you click it, it will open. See if that will work for you. You could also, if, if, if you go to YouTube and type all brains belong VT, you'll find, you'll find our station and it should be the most recently posted video. If you write on the URL also, you can copy it. Even if you're not a host? Oh, maybe because I'm one of the, I was able to. I don't think you are a host, so that's cool that that worked. Yep. No technology. She says open link. I'm sorry. Cool. Open link. Yeah. Amy. Well, I just want to say thank you to the three of you because, you know, obviously, as I am a medical patient of ABB, and, you know, I'm always on the other side of just receiving the information from the three of you. And I just thought it was incredibly generous of all of you to kind of share the vulnerabilities of, you know, having this education, having this training and then sort of moving outside of that model and the risk, you know, even professionally that you're taking to, to be, to like care for all of us. And that, that really it's been such a huge result for me having, you know, you'll hear everyone will hear next week, but that, you know, basically I haven't had healthcare until now. And so I just felt like it was incredibly generous of the three of you to share your experience. And yeah, I just, I really honor all three of you for what you, who you are, what you're doing. And I, you know, if the medical system is willing to like even come in and see what you're offering, I think that they would be really blown away for the results that you're getting. So thanks so much. Ewayne, thank you so much. You know, I think I don't, I think that I don't, I mean, I wouldn't have had language to describe this when I was in my old life. It was not until like it's, it's like the ability to zoom out and you know, understand nervous system regulation. Like when you're, when we say like the rest of the healthcare system, it's like the difference between the healthcare system and the people in it. I think the people in it are for the most part, like really well intentioned and often really quite dysregulated by by the healthcare system. And I think until I mean, it's like it's, it's like when you think about all the medicines, not the only profession where, you know, burnout, you know, the epidemic of burnout, like it's, it's, it's when the system thwarts you, thwarts your access needs from being mad and you don't even know that you don't even know what an access need is, let alone what yours are and that it's like what you do for a living that thwarts you, like that sucks, that sucks a lot. And so it, you know, I can only speak for myself in that, you know, as, as an autistic person belonging to autistic community and like trying to do it differently within this community village model, like it just, I really can't imagine any other way to practice medicine now that I've lived it. Because I, I, I think it's like when you think about the, you know, just even having transparent conversations about access needs, like it's, I'm not going to put, I'm not going to put you on the spot, I mean, I'm not going to put anybody on the spot, but like, you know, sometimes it kind of sucks to be a patient here, you know, we don't answer the phone. You know, you know, it's because we don't have the kind of brains that can answer the phone and see patients at the same time and we tell you that and like we're just kind of modeling, like what would it be like to be in, in, in a community in relationship with other people where you transparently showed up the best you can and made it okay for everyone to show up the best they can. And that's, there's a lot of learning that would have to happen for a lot of people because specifically how medical education teaches not that. I just want to say really quick that I know that that's something you have up front and I don't know what other, I don't want to say what other people's experiences are, but my experience is like if I text, it's like somebody in the team, whether it's like Lizzie or Olivia, like it's just like the way that you created this, like I don't feel, I feel cared by, you know, for by everybody. And so if I am to text, I do feel like I get an answer, whether that's like a prescription med or an upcoming appointment. And it's like, it does feel like the team of people know me and or getting to know me more. And so it feels better because I don't actually want to make a call, I'd rather have to send a text. It's awesome. Sarah. You know, I, one of the things you're making me think of is this, is kind of the cost of this emphasis on professionalism. And because, because the emphasis on professionalism seems like what you're getting people to do is to identify first with a profession and, and first with other professionals and, and, and with the, the profession that employs you and, and the, the, and that's in contrast. And so now you can't show up as you, you have to show up as this expert. And, and, and that's very different than healthcare as community. And, and so it, it really prevents you from showing up as a person. And, and I think it also leads to a lot of lawsuits because now once you've held yourself out as this, this person that's got, like, got this big extra special expertise that's supposed to know everything and belong to this profession that knows everything. Now you're suitable. And, and if you just show up as you like fallible, vulnerable human being that's trying their best and doing their best, then it's out on the table. You know, fallible, vulnerable human being trying their best, doing their best, but going to make some mistakes along the way that's part of the package. If you want healthcare here, that's what you get. Right. And I think that, you know, what I connect from that is also what we know is that relationships are everything. And it's, it's, it's really about reflecting on what goes into a healthcare relationship and like maybe, maybe rethinking a lot of, a lot of, a lot of the things that, that, that medical education truly explicitly explicitly teaches that often interferes with relationships. Sierra. Yeah, I think just on that point, Sarah, I think that it's, there's, it's so common in that like zone of professionalism to teach people to hide certain things about themselves. I mean, I, I was definitely taught in school specifically to like not tell patients or other providers about my like sexual orientation. And I think that's why a lot of healthcare providers who are neurodivergent aren't disclosing that to their employers, not exposing that to their coworkers and definitely not exposing that to patients, because it's, it's viewed as such a liability. And that means we have less representation. That means we can't connect with people as much. It's yeah. Thank you, Sierra, for saying that. I mean, I even, I remember, I remember even as a, like, as a resident, like, I don't know that anybody like explicitly told me to cover my tattoo, but it was like strong, it was like strongly implied that there were looks. And like, when you really think about how that's not even an aspect of identity that someone is hiding of who you authentically are as a person, like if you are explicitly taught, hide your true self at that game. Now that we're in like, you know, in our new real lives, right? Like, how often does some form of disclosure or just like some sort of sharing of something about one's authentic self is what cues safety for a lot of our patients. And that's, that's the opposite of what I was taught and like obviously it makes sense. So with that, this is a great segue to next week's topic. We will be hearing from a community panel of neurodivergent folks sharing their experiences interacting with the healthcare system. So part part two of this conversation next week. So thank you all. Thank you all so much for being here and I hope you have a great week.