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Hi guys. Um Welcome. My name is Frida. I'm the president of GP Society. Um We're gonna make a start around six o'clock. I think people are still very much coming in, so I might also just give them five minutes. Um So, yeah, welcome. Hi guys. Thank you for coming. I'm just gonna give everyone five minutes to kind of come in cause I can see a couple of people kind of trickling in. So I'm gonna give them a chance to um join before we all start. If that's OK. Hi for everyone coming in. We will be starting in two minutes. Sorry for making some people wait. Um We've just got a few more people that's come right. It's now five past. So I think we should make a start. So, first of all, welcome to our communication skills workshop that will be going through explaining a diagnosis slash procedure. This is our second. This is the second part of our four part series. Last Tuesday, we had Omar who basically spoke about history taking and this week we've got Ash Finney. Um So the for the rest of our episodes, this will be advertised on meal and of course, our Instagram as well. So please make sure you follow. So you guys don't miss out. Um So, like I said, we have Ashvin who's one of our fifth years and she's going to be going through the steps of explaining how to um explain a diagnosis and a procedure during Aussies. And we hope that this will be an interactive session. So please make use of the chat and we've changed the function. Now, last week, um you guys wouldn't be able to kind of use your mics, but this week you can. So, but also please be mindful, put it on the chat first just so that we're not talking over each other. I think that'll be easier and you guys will also have time at the end for any questions that you guys have. So without further ado I'm going to pass it on to Ashman. Perfect. Uh Can I just check that everyone can hear me, Frieda? I can hear you and everyone if you can put it on the chart that you can hear us when you please? Perfect. I won't be able to see the chat myself. Um but Frida will kind of just read everything to me that's um been put on the chart. So um as Fried has explained, this is the second part of our communication series. And um we're doing this as part of our GP society at the University of Lincoln and um the main purpose of this is for it to be um useful in terms of OS prep. Um But, you know, as 50 year students, we understand that it's very um useful for us going into like the transition uh into being, becoming a junior doctor. Um So it's really uh transferrable skills that you'll be able to utilize, I think um in whatever stage you are at right now. No. So um the aims of the session today is to um like Frieda said to explain um a diagnosis to a patient and also to explain a procedure to a patient. So they are, they have their similarities um in how you'd go about these, but they also have their differences. So we're gonna go through those individually and just like a reminder as to like why this is relevant in terms of the Aussies, I've just put up the different osk stations that you could have. So, um, we've already had our history taking session covered last week. So that's one of those stations. And then I've highlighted the clinical reasonings, including investigations which kind of comes onto this and the explanations, which is what we're gonna be focusing on. And um as you can see like the domains that you get assessed and marked on, um, we're gonna uh try and cover like how these would be relevant and how you kind of come under all of this. Um So, yeah, this is just um, a little reminder as to how it's useful. So I'm gonna split this. Uh We're gonna talk through explaining a diagnosis first, I'm gonna go through the procedure. Um Then I'm gonna do explaining um a procedure and then I've got two examples at the end for each. Um We'll try and get through both of them. Uh If we are short of time, uh I am aware that uh we wanna leave some time for questions at the end. So if there, I if we are short of time, I might only go through one and then um potentially these slides can get sent out for you guys to like go through this at your own pace. So just as an outline, um first of all, uh as to like the major headings that we're gonna go into for explaining a diagnosis. So we're gonna start with our introduction as we do for most things that we do um checking the patient's agenda, checking the patient's prior knowledge, setting the context, explaining the actual diagnosis itself and then closing the consultation. So um we're trying to keep this interactive. So I wanna hear from you guys. Um First, what you think comes under the introduction, it's pretty much the same for a lot of things that we do in terms of like a stations and medicine. So if you guys can like put in the chat, what you think comes under this introduction section and then Frida if you could just read out the responses for me. Yep, I can do that. I'm just waiting for everyone to type up their answers. Ok. Which is the, so Simon said, introduce yourself, confirm name and date of birth. Yup. Yeah. And someone else has said something very similar, introducing yourself your position and confirming patient name. Perfect. Ok. I'll go through what's on the slides. So start by washing your hands. Um An important thing for most osteo stations, it gets you um an easy mark. Um If you do it uh and remember to do it, introducing yourself. So this includes your name and also um your role. Um I know that personally, I find that sometimes in an OS station especially it would say on the outside of the station that you're a junior doctor. So just make sure that you say that you're a junior doctor and not like um for instance, a third year medical student or something, then you wanna confirm the patient details. So usually you aim to get like two indicators. So um their full name and their date of birth is usually the go to, then you want to explain the purpose of the consultation and after this, you will gain consent and you also confirm that the conversation that you're gonna have will remain like confidential. And then just generally as well, a point to note is that you're trying to build a rle from the beginning. So it's just making sure that right from the start you adopt that friendly manner, um express empathy throughout. And also I find that mirroring the patient in terms of body language can also help this as well. So then uh we move on to taking um a quick focus history. Um So what I mean by a quick focus history is not going through the entire kind of like checklist of history of presenting complaint, past medical history, drug history, social history. That's not the purpose of this ACU station. Um But we do want to explore the patient's condition or presentation and the reason behind um why they're here today. So it will help you understand um a little bit more about how to go about the explanation. Um and uh what level of information to give to your patient as well. So in the quick focus history, mainly, you just want to be looking at the presenting complaint that the patient originally came in with. Um And uh just uh again, I think it's also just a good way to indicate to the patient that you're not looking for um a detailed history just to mention that when you say to them. Um can you just uh word it so that you say it's that um it's kind of you briefly summarize for me like um what happened and what brought you in in the first place? I think it's a good way for them to be able to summarize as well. Then we want to check the patient's agenda. Um So before delivering uh the information that you have for the patient, um it's important to check to see what they're expecting from this consultation. Um And it's uh good to match their expectations to what you're about to give them. So, are they expecting um to receive something in particular? And is their expectation the same as yours? Um You also want to check that if they're ready and willing to receive the information, some people might not be mentally prepared for it. So, um you don't want to force it upon them. And again, you need to check if they're expecting to receive information at all today. And uh if they were, were they planning to discuss like something else? Um as well, that's uh you wanna make sure that you're on the same page about things, then it's good to kind of adopt the ice kind of um method for this. So, does the patient have any ideas about what might be causing their symptoms? Um Do they have any particular concerns at this point regarding um their symptoms or receiving their diagnosis? And just again, what they're hoping to get out of the consultation today? So checking the patient's prior knowledge. So you want to check to see what the patient already understands um about the subject. So it can help you avoid repeating information that they might already be aware of. Um It's also important um to find out how much they know already so that you can deliver your information at like an appropriate level and it will allow you to kind of word and adapt your questions depending on what they already know. Um So for instance, um patients usually have had multiple consultations, so you can check to see if like their results are explained um in a previous consultation. Uh and you can ask them to kind of um talk you through what they understand about their condition. Um So another key thing is to avoid interrupting the patient at this time. So you want to allow the patient to say everything they want and um avoid interrupting them. Um So if they can explain what they already know, just listen carefully and watch their facial and body language, so it can help reveal that their understanding might be correct or incorrect. Um It can elicit certain emotional responses associated with the matter. So it will help you kind of adapt the way that you deliver your information and help you be cautious if you are going to discuss something that might be sensitive for the patient. So then setting the context. So um after you've checked the patient's agenda and their prior knowledge, you can begin to provide them with the information. Um So you want to signpost if not done already about what it is that you're going to talk about. Um it's best not to spring it upon the patient. Um So uh give them like a little bit of um a trigger or warning that you're about to start discussing stuff with them. Um You can also explain uh the steps um that you're about to take, for example, you're gonna talk about what the condition is, how um uh the doctors have come to this decision, what your symptoms might be and how we're gonna manage this. So it kind of um briefs the patient beforehand, so they know what to expect and you just wanna double check that the patient is happy to have that conversation. Now, um Also you can check if they'd like somebody else to be present with them, especially for more like sensitive topics, then you get to the actual explanation of the diagnosis. Um So there's quite a bit to cover in this and it will vary depending on the diagnosis. Um So it's just giving the patient enough information, um an explanation as to their diagnosis. So you're gonna wanna start maybe with like a definition. So a brief overview of what the condition is. Um You wanna go through uh how that condition could present and link it to the patient's symptoms. Um If there is like a cause, you can um uh explain that to the patient and if not cause perhaps risk factors and things that could contribute or make their condition worse. Um I've already said like linking the patient's symptoms up to how their condition presents, then you want to go through, um, if there were like any investigations that were done in order to come to this diagnosis. So it offers, um, kind of like you're backing up your information kind of thing to the patients so that they know that, um, this hasn't just been kind of pulled out of thin air and there is like a logical reason as to why this diagnosis has been given to them. Um, and then at this point, you can open up the conversation to discussing treatment options if they wish to. Um it is a lot of information to di uh to digest. So uh some patients might want to uh just kind of think about it and come back when they've had like a bit more time to process the diagnosis and then receive information about um management and like potentially starting treatment and then just some important things to bear in mind whilst you're explaining the diagnosis, you want to um break down the information into small chunks. Um And uh this will help the patient um hopefully um absorb the information better. Um And they're more likely to retain things as well by doing this. And you want to also make sure that you avoid using medical jargon, it's very easy. Um I think for doctors, medical students to do this. Um but just making sure that the language that you use is understandable for the patient. And then just again, inviting the patient to interrupt you, if they can't keep up or they don't understand something. Um I think allowing pauses whilst you explain the various aspects of the diagnosis will allow for this to happen. And if not just make it clear from the start that, you know, if you do have any questions or if you don't understand something, feel free to either interrupt me during whilst and speaking or just ask whatever you want to at the end, but make sure that the patient is aware that they are allowed to do this. Um You also just want to look out for non verbal cues whilst delivering the information. Um some patients uh may not uh react verbally but um from their facial expressions, from their body language, you might be able to see um if they're upset or if they're surprised or just their emotional response to the diagnosis. And you can also check the patient's understanding at regular intervals as well as like allowing them to ask the questions just to make sure that they're absorbing the information. This can be difficult. I know in like an ay setting where we're limited to 10 minutes. Um but it's just something that um is a good habit to adopt. Um And you do want to acknowledge the fact as well that this information can be complex and overwhelming. We're talking about a lot and for some patients, it might be unexpected and very new. Um So just bear that in mind and again, like allow for pauses, allow for breaks in the information so that the patient can um just keep up with everything and process everything. So then we move on to closing the consultation. So you just want to thank the patient for their time. Um You can offer them supporting written materials or website links to read more about the topic. Um I find that in an Aussie situation, especially if um you don't have all the answers to a patient's questions or if you weren't able to provide them with details, enough information. This is a good way to kind of um almost cover your back and make sure that you've not left the patient completely hanging. Uh Again, offer the opportunity to ask questions at the end if they do have any. And again, you want to acknowledge and reacknowledge the fact that you've given them a lot of information in one go and um that if they do have any questions, even after they've left, they're welcome to get in touch and um speak to somebody about it. Then again, just washing your hands at the end, uh disposing PPE uh things that become like pretty routine once you uh start uh start kind of practicing these things. So that is it for explaining a diagnosis. Um I hope everybody was able to follow us easily before you move on to explaining a procedure. We just have a suggestion from somebody. I think it's so sorry, I've said that wrong and they've said as too much information to deliver a better way would be asking the patient what they want to be discussed in details. What was that? Was that a question? Can you just repeat that? No, it wasn't a question. I just wanted to acknowledge that their um comment it. Can you just repeat that? I lost you there. So I just like what we said in the, can you hear me? Oh, it was just a suggestion and they've just said that as too much information to deliver, but a better way of doing it would be asking the patient, what do they want to be discussed in details. So I'm guessing they just are saying good suggestion and I guess that really allows for like the patient centered care approach. Um So obviously, not just bombarding the patient with information that we have to offer, but yeah, allowing them to choose like what they want to hear and what might be useful for them. Yeah, that's a good suggestion. Thank you. Ok. So I'm going to move on to explaining a procedure. Um The basic outline might be quite similar to um explaining the diagnosis, but obviously um the actual explaining a procedure bit is different. So again, we start with our introduction, uh we will go into an ice kind of format. So the ideas concerns and expectations uh again, take a quick history, then explain the actual procedure and then close the consultation. So uh introduction is basically the same thing. So wash your hands, introduce yourself, um including your name and role, uh confirming the patient's name and date of birth, explaining the purpose of the consultation, gain consent and similar things just try and build that rapport from the beginning, adopting that friendly manner, expressing empathy and just mirroring uh the patient as well. And yeah, things that you do throughout, like I said, build the repo have an open line of communication and provide the opportunity to ask questions throughout. So in terms of ice, um we've got ideas. So just in the chat, what kind of question would you ask about the ideas in this context? Rider if you can just read out what's being said to me? Yeah, I'm just waiting for people to write their answers. Yeah. So it's in the context of explaining the procedure. So just bearing that in mind, what would you ask it can be about any bit of the ice as well. So either the ideas, concerns or expectations, just how would you word it is my question. OK, because I'm cautious with the time I'm just gonna start going through the slides. So, uh in terms of ideas, you wanna check what the patient already knows about the procedure. Um Again, cos you don't wanna repeat information if they're already aware of it. Uh So concerns wise is that anything that's um worrying them regarding the procedure Um And then expectations is what the patient is hoping that you'll be covering. Um Is there anything that they wanted to focus on and just what they want to get out of this consultation? Uh So history is um essentially the same. So it's having that quick focus history to allow you to explore the patient's presentation, the reason behind why they're needing this procedure, so it can allow you to adapt your explanation um uh that you give to the patient. So in terms of um actually explaining the procedure, um so there's a lot to cover in this. And again, it will vary between uh the procedure that you are um explaining to the patient. Um But generally, you're gonna kind of give like a brief definition um as an overview of what the procedure is. Um again, making sure to like explain it in um nonmedical terminology that's um kind of patient friendly. So you want to explain sort of what it's used for. So some investigation methods can be used for multiple different reasons. So it's important that you highlight to the patient um the reason behind the choice of this procedure and maybe in particular what you'll be looking for. Some patients might associate certain procedures with something more concerning or scary. So they might already have like an opinion about it. So you just kind of want to break that and clarify that for them. Then uh you wanna kind of discuss like the benefits versus the risks of the procedure. Again, this is um very different based on the procedures that you're going to talk about, but kind of weighing things up for the patient, uh justifying the choice of procedure can be done by like explaining the benefits. But um you're also kind of obliged to talk about the risks. And um it's also useful maybe to put numbers and ratios on things just to explain to patients how big or small a risk can be. So then um you want to talk about uh duration and location. So um uh in terms of duration, some things might take longer than others. So will it require um you to take time off work? It might require an admission for a day. Um Is it something that happens at the hospital at the GP? Um This kind of information is um useful for the patient, then what does the procedure itself involve? So, uh this is best to be broken down into like that um before, during and after. So, uh some procedures need some form of preparation before. Um There's elements to be aware of during the procedure and then um after it, how might they feel or things that they should avoid or be aware of and then side effects. Um as there are to most things you want to go through these and um just talk about uh mainly the common ones uh that patients should be aware of and then again, you uh close the consultation. So you want to thank the patient and in this one especially, it's good to summarize what you've discussed and emphasize on the key points of the consultation. Um because this is something that the patient is going to have to go through with. So it's just um good to make sure that they're aware of the important points. And to back that up, obviously, you can give the supporting Britain materials or website links and then um you offer the opportunity to ask any final questions that they might have and answer this then and then again, just washing your hands at the end in an aus, it's all, it's all important. So that is the outlines of both explaining a diagnosis and explaining the procedure. Um So now I'm going to go into examples for each. Um I've kind of broken it down in terms of the outline and kind of given suggestions as to what you'd do under each. Um So I'm just gonna start talking through that if nobody has any questions or anything right now. So I've chosen to do um the diagnosis explanation on schizophrenia. Um I always find that sometimes, especially in an ay, the psychiatric stations can be uh the challenging ones. Um So I've chosen to do the diagnosis and procedure on um two of those. Uh So hopefully it's useful. So um as the outlines briefed already, we want to do the introduction. So uh checking the patient's um name, date of birth, introducing yourself, washing your hands, um and going through that whole section there, then a brief history of the patient's uh details. Um So again, that presentation, so um this could be a collateral history as well. I forgot to mention from in terms of schizophrenia, some of the stations might be explaining it to a relative um or talking to a friend. So you want to get a brief history about the patient's uh presentation. So what made um somebody uh want to get this diagnosis in the first place? So then you want to um talk about either the patient or um their relatives understanding about schizophrenia. So you're gonna ask about um their ideas regarding symptoms of um schizophrenia or just schizophrenia in general, you're gonna ask them about their concerns um regarding their symptoms or their presentation or receiving a diagnosis of schizophrenia and then you want to um elicit their expectations. So what they're hoping to get out of this consultation. So uh then you're gonna deliver the explanation itself. So you're gonna signpost them and just um tell them that we're now gonna discuss in a bit more detail about schizophrenia and what it is. So what is schizophrenia? So, um just a brief definition to kind of introduce it could be that it's a long term mental health condition. Usually when you say schizophrenia, people might already have an opinion about it So just saying that um just owing the fact that it is just a mental health condition, um is a good way to kind of break into it. And then you can talk about what causes schizophrenia. So this is um like a, a wider picture kind of thing and you can just offer um explanations as to what it could be. Um There might not be a specific cause for the patient but acknowledging things like family history, um could be one of those options there. Then you can talk about the patient's symptoms. So um from the history that the patient or the relative is given, you can link up their presentation to the symptoms of schizophrenia. So this can include psychosis. So um this kind of covers delusional thoughts, hallucinations, both auditory and visual and then any thought disorders. And then you can talk about how patients might have a lack of insight and just a general kind of reduced level of functioning. And then again, if the patient wishes to kind of hear about the management, um you can kind of lay out the options of management, usually in an explanation of a diagnosis. This is um kind of more detailed but and you won't have like an official um management plan. So you can just kind of like lay out your options. So um things like early intervention, psychosis, um having access to crisis teams um making them aware that if they do have like an acute episode, they can get admitted into hospital for like immediate treatment. Um and uh making them aware of like the community mental health teams and how their input might help. And then in terms of like actually treating, then you can um just mention that uh antipsychotic medications are an option as well as cognitive behavioral therapy. Um Again, this is a lot of information. So just kind of reminding the patient that um this is overwhelming uh and the fact that they don't have to receive all of this now. And um just making sure that they understand what you've said to them is a good way of just ensuring that they're engaged with it, then you just want to close the consultation. So again, you can summarize what you've um said to the patient, um offer them the opportunity to ask any questions um providing uh like information leaflets or website links with the information that you've just verbalized to them is useful. And um yeah, allowing them to get in contact if they have like future questions and stuff. So that's the explaining a diagnosis of schizophrenia. So then keeping in line with the psychiatric kind of theme of things I've chosen to explain ec T um this is an OS station that I got um and found difficult. So I thought it might be useful to kind of um explain uh and go through this way for you guys. So uh following like a similar kind of pattern. You want to introduce yourself. Um get consent from the patient, get their details and um wash your hands and do all of that stuff. Then we're gonna start with ice. So sorry that heading must be wrong. It's not about ec T it's about colonoscopy. I did. Yeah. Ignore what I said before. I think I said um it's two psychiatric patients. It's not, it was one and then something different. So it's colonoscopy is what I'm explaining today. So uh we're gonna do the ice for colonoscopy. So it's what they already know um about having a colonoscopy. Um If there's anything that's uh worrying them about having it and what kind of information they were gonna get uh that they were hoping would get covered. And then again, you're gonna wanna take that um brief history um from the patient as to um what kind of presentation they came with um uh what symptoms they had and kind of just the way in which it was decided that they needed to get the colonoscopy. So then we're gonna go through the explanation. So for colonoscopy, um there is a lot to go through. Um So again, just maybe warning the patient that it's a lot of information um and kind of uh outlining to them beforehand what it is that you're gonna be talking about and uh maybe just um getting from them like which bits of this they were like particularly wanting to, um, know about. So things that you could talk about. So just again, like what is it? So offering them like a brief, um, understandable definition. So something like it's passing a long thin tube that has a camera attached, um, through your back passage into the large bowel, um, to allow us to look at your bowel. So then you can offer them like, um, a reason as to why it's being performed. Again, this will depend on the history that your patient has given you. Um But I've kind of given some ideas as to why it might be performed. So patients can have rectal bleeding, um altered bowel habits, um an unexplained iron deficiency anemia, um unexplained weight loss, um So persistent abdominal symptoms and screening. So a lot of these um go along with kind of like that kind of bowel cancer kind of idea and then um something you could talk about um is alternatives. Um So in particular for a colonoscopy, a ct colonography or a virtual colonoscopy can be offered. Um So it's good to make the patients aware of all of their options, but then you can kind of um um counter this by backing up your choice. Um So just kind of explaining the colonoscopy, um uh might be more invasive, but it is preferred because it gives a more detailed um visualization of um the things that you're looking at. So the mucosa it allows for biopsies to be taken and simultaneously, you can also remove any lesions that you see then and there, uh then just um going through that kind of before, during and after the actual procedure. Um So before uh a colonoscopy, you'd go through bowel prep. So this is usually like a low fiber diet, 2 to 3 days beforehand and also just increasing your fluid intake. Um and also um patients will get prescribed a very strong laxative. So it's important to warn the patient that this causes diarrhea. Um, so that they can kind of prepare for this, make sure that they're either they take time off work or they have access to a toilet nearby at all times. So it's very important to warn them about that. And then patients also shouldn't eat anything on the day. Um, but they can, um, drinker clear fluids up to two hours before the procedure and then just, um, some, they're like important bits about during the actual procedure. You want to take consent from them again on the day, sign those forms. Uh And then you have options. So patients can either be sedated or they can get gas and air. Um, you can tell them that it roughly lasts about 20 to 40 minutes. Um, you'll uh inform them of who will be in the room. So it's the person that will be doing the endoscopy and usually there's two nurses as well. Um, you'll tell them about um, uh, how they have to position themselves. So you lie on the left and then bring your knees up to your chest. Um You'll do the rectal examination before um actually passing the colonoscope through the back passage. And then you will also, um, tell the patient that they might have to adjust positions throughout as well. And then after the procedure, they will go into the recovery room for monitoring. Um, you should warn them about not driving after it or signing any legal documents or operating heavy machinery for 24 hours, um after the colonoscopy. And then, um, if it's appropriate to do so, you can um uh discuss the findings, uh if there are any, um and uh offer that to the patient as well. Then in terms of side effects, um some of the key ones for colonoscopy will be nausea, bloating, um some crampy abdominal pain and, and maybe minor rectal bleeding. And then the risks of this procedure that you can explain to the patient would be having an allergic reaction to any of like the equipment or meds used throughout the procedure, heavy bleeding, um bowel perforation, um an incomplete examination or there is a small risk of missed um, pathologies. Um Again, with all these like risks and side effects, it's good to warn patients of like these are the common ones. These are um much less common and just kind of um clear that for them and then you just want to close the consultation and um uh offer them again the opportunity to ask questions summarize and again, backing up with information leaflets or links to websites and things that is the end of my presentation. Um I hope that was easy to follow along to and if there's any questions, I'm happy to answer any. We would you like to come back, Ash Penny? So you can see the chat as well. I was gonna say, I'm gonna stop sharing my sides now. Yeah. Um, everyone, if you guys have any questions for, for you, please use the chat. But you can also, I think some of you guys have the options to put your mic on. So if, if you know that's your preference, that is also thank you guys um, for uh joining, I can see the chart. Thank you guys for the compliments. Um Yeah, there's, if there's no questions, I don't think there's any questions. I think you did so well that nobody needs to clarify anything, which is always good. I'm gonna assume that. Yeah, I think somebody's joined with a bit of a delay. Um I think it's really hard to summarize in a couple of minutes. I think we might just be able to maybe send the slides over Ashwin. I think you said you were happy. I'm happy to send the slides over via email or something. Yeah, I think only because we're wary of timing and I don't want you to have to summarize a 50 minute consultation in that short of a time. I think we'll just disseminate the slides if people are happy, if you guys want that, maybe put it on the chat and we'll just note down the people that want them um with your email, please and then that would be very useful. So, thank you everyone for coming. Thank you, Ashvin. Like I said, that was a really, really good informative, really helpful presentation, not just, you know, helping me out fifth year. I'm sure it will be really helpful for the year, but as well, who will be having their ay soon, sorry, trigger warning. Um So if I can also remind everyone to please fill um the feedback forms to be able to get your certificates. Um This will be really useful for Ashvin as well if you know, you give her some feedback of her amazing job today. And just like last week, we are going to be sending out crib sheets to GP sock members. Um The one from last week is still yet to be sent, but we will be disseminating that to our members very soon. So if you haven't gotten um a membership yet, please make sure you get that and other things. We this is only part two of part four. So we have two more and it will be every Tuesday um at 6 p.m. So it'll be the same time. So um I look forward to that. I think our next session is on drug counseling. Um So we hope to see everyone next week as well. Thank you. Perfect. There's loads of people that have put their email onto the chat. Yes. Oh, yeah, we will be able to do those on the form as well because we ask your email on the form. So I think we'll disseminate it through then as well. Perfect. Thank you very much guys for joining. I hope that was useful and do join the future ones as well. They happen every Tuesday like Frieda said. Uh Thank you. Thank you, Ashman.