All Brains Belong VT - Brain Club: Burnout Prevention in Healthcare 8/18/2026

Hello everybody. Welcome. I'm Mel Hower. I use she they pronouns. Welcome to Prink Club. So tonight we are going to be talking about burnout prevention in healthcare. And you're going to hear from a group of our staff talking about how we have um endeavored to build a healthcare experience here where we are thinking about caring for our patients and for each other and really trying to reframe those and and this isn't just in healthcare. It's everywhere, right? like the self-care narrative that says that the individual has to do things to take care of themselves when really this is a systems problem. So, we're going to talk about how do we build a system that takes care of people um and puts the onus on the system as opposed to the onus on an individual to fight a system. Before we begin, close captions are uh enabled. You just have to turn them on if you want to use them. Depending on your version of Zoom, you might see the live transcript close captioning icon. If not, look for the more dot dot dot and choose show subtitles. You can also do the same and choose hide subtitles if you want to turn them off. Um, welcome if you're new to All Brains Belong. Um, we're here to support the health and belonging people with all types of brains and we do that in lots of different ways, including brain club. So, we're really glad that you're here being part of what we're doing. Brain Club is our education program where we demonstrate ABB's approach to neuroinclusive culture and where we try to shift broader community awareness of the issues of concerned importance to our community. It's also a space where we broker alliances with other communities who come to learn so that we're hopefully promoting new ways of thinking and being and then everyone takes this forth into the rest of your lives and that's how culture change happens. Everyone's welcome here at Brain Club. nerd diverent people, people who support neurody divergent people, people who are exploring their neuro identity, and anyone with any type of brain who wants to learn about neuroinclusive culture. There are multiple right ways to participate here. You can have your video on or off. Even if it's on, we don't expect anything of you. Uh feel free to walk around or fidget or stim or eat or take breaks or anything else that needs doing. And uh this is for education purposes only, though, you know, we're going to be talking about healthcare and the healthare system. Um, this is not for medical or mental health advice. It's not a place, it's not a support group. It's not a place to discuss one's own trauma um or make individualized requests. Um, and uh we we keep the focus on bright spotting. Um, figuring out what's going well and carrying it forth. Um, when we do critique, we crit we we critique systems. Uh, we do not blame or shame or bash or criticize groups of people. So, we invite you to listen to learn to observe a neurocclusive space. Maybe pick up some new words and concepts and think about how what you hear connects to your life. If it's your first time at Brain Club, keep coming back. It might take a couple times to figure out the space and how we facilitate it. We recommend observing the first time or two. And Lizzy's going to put some frequently asked questions in the chat. Um during our panel, we do automatically mute everyone until the panel ends so that there are no auditory distractions and people don't have to worry about keeping an eye on your mute button and all that stuff that you know, you lean on your keyboard the wrong way and it turns on. So, you don't have to worry about that. Okay. Thank you to the Alchemist for sponsoring tonight's brain club and thank you to all of you for supporting brain club, making it possible for us to be here. Um, running on almost 5 years. So, um, to preview next month at Brain Club, we are going to be looking at reimagining systems. Um and uh you'll you'll you'll find out on the next slide why um why we're calling this the theme, but we're going to talk about systems change throughout the month. And uh the reason that we're calling our month theme of Failure of Imagination because our new book of Failure of Imagination is now available for pre-orders. Um and Lizzy's going to put a link in the chat if you want to check it out and see what it's like. Um it'll be available for print book and ebook. There will be an audio book, but pre-orders for the audio book have not yet started. This book will be released later in the fall. Um, but we're going to be uh starting the process of unpacking it in September and October and looking at some of the themes and resources. Um, next week we do not have a normal brain club. In the same time slot um as brain club, we have a special book oriented event for folks who um are part of the pre-order community. um a book uh question and answer with me and our team. And Lizz's gonna uh Lizzie has already put the link in the chat for pre-ordering. Um but we will be back on September 1st, the following week uh resuming uh weekly brain club. So um I always say this, I always offer a disclaimer when we have healthcare focused brain club sessions. Um because of course uh there's lots of people who have had lots of bad experiences in healthcare both as patients and as clinicians. And so we just um we like to name that we invite you to you know do what needs doing, take care of yourself. If thinking about healthcare is really stressful and you take breaks like um all all of that is valid. We know that the status quo of healthcare for neurody diverent people is not good. We know that neurody divergent people often struggle to access health care and often struggle with high rates of untreated health problems and higher rates of chronic illness and premature death. And um part of our work here is in reimagining health care is to try to make an impact on that to be able to offer accessible health care um informed by you know the medical conditions that are more common for neurody diverent people. And when we think about the people who work in healthcare we've covered this at Brain Club before. We've had community panels um of of of healthcare workers talking about how the system it's really it's it's it's the health care system that is the villain here and it thwarts both patients and clinicians alike. Um so tonight we're going to be hearing from a panel of our staff at All Brains Belong sharing what we've learned. This panel was recorded um about a a little over a year ago and so we'll be revisiting this conversation um see what what what's changed and what's the same. Um but the idea of you know what are some of the practical things that that we try to do differently here so that this is sustainable work where patients and and our team can um have our access needs met. Access needs being what anybody needs for full and meaningful participation. So thank you to our panelists Olivia Tyler, Lizzie Pat, and Sierra Miller. Um while we watch the panel um you are welcome to use the chat. Um, just as a reminder, we we treat the chat as equivalent to mouth words. We welcome chat comments that keep the focus on the panelists. And so, uh, with that, I will switch to our video. Except I never remember to share sound. Let's try that again. Here we go. Burnout prevention and sustainability in healthcare. Can I go off script? I had an interesting idea. Olivia Sierra and I, we've worked in traditional healthc care environments, but Lizzie has not. I sort of like that's interesting to me. I don't know in what way that conversation like and it was like it's like norms that there were norms that you had to unlearn versus like a fresh approach to like the creation of something. I don't know. Does anybody have thoughts about that? I feel like a lot of the norms that make working in healthcare difficult. A lot of the like structural aspects are very similar to working at a lot of large corporations. So I feel like there's some of them that are some of the things of unlearning is is going to be pretty universal in a lot of different especially like large systemic structured industries with a big hierarchy. >> That's very interesting. That makes sense to me. Last night I had a conversation with Scott. Never we guess we've never talked about like the health care system dysfunction. Like I guess he's like wait why do you what do you what's wrong with the health care system? It's like really anyway um so um he's like I when you talk about the health care system you are talking about the business model of traditional healthcare environments that is not quote the health care system that is a business model that you don't agree with. I'm open to the idea but like the business model is see as many patients as possible. I don't think that you can separate the business model from the actual health care being delivered. They're they're they're one and the same. I I don't know if this will get to say, but it it feels similar to being like, oh, you're focusing on politics versus like civil rights. like they're they're so intertwined and yeah, I don't I don't necessarily know if if they can be separated, especially given that we, how do I say this? Especially given that a lot of the the business models are profit focused often instead of um instead of patient patient focused. [snorts] >> That's fair. traditional health care see as many patients as possible so that more revenue can come in >> and to like make it actually to for the healthcare to be patient focused the business model has to be patient focused as well >> what would that look like >> I think it's focusing on patients not profits >> concrete thing I would say is that We see literally as few patients as possible in order to cover our expenses. Other than that, we're trying to get people appointments when they need them, right? Like we're focusing on like bare minimum number of appointments. The schedule is set up that way. Sometimes we end up seeing more like we were talking about before. Um but that's the structure. It's not how many patients can we fit in the schedule. Like that is a structural difference that I think impacts my mental health and is probably good for patients. Sierra's thesis is that like if we think about like the sustainability of working in health care, patient focused healthcare feels better to deliver. >> I think having like patients the community and like direct care staff being intimately involved in like the creation of the business model is also a really important important part of that. Um because otherwise you don't know what patient care looks like if there's only people who aren't ever interacting with patients deciding that. >> Totally. Are there other aspects of like traditional healthc care delivery or like traditional corporate delivery that anyone else has had to unlearn? Olivia, Lizzy, anything you want to share in that regard? Well, I don't think it's possible to have um patient centered care if you're also if you're not taking care of your staff because they don't have the bandwidth or they'll have the bandwidth for a certain amount of time and then they're in burnout and they're running on empty and it's hard to take care of your people when you're not taking care of your staff. So, >> totally. And like I remember in traditional healthcare there was this narrative like people were talking about how like you know to heal a person you must be a person and work life balance and mindfulness and it was all like you as the individual you need to do self-care and like then you can be a good clinician. It's like the system is actively hurting me right now. Mhm. >> And so I think that to your point, it's the system. >> Yeah. >> Taking it's taking care of the people in it which includes patients and includes clinicians and everyone who works in the system. Yeah, it seems like and I think that it goes across the board the companies or practices or if if they're if they've worked in every aspect of the system, then they can at least understand where everybody's coming from and be able to show up in a different way. It seems like if to be successful and to for everybody to be happy, you have to have experience in each department of your practice or each, you know, it's like even in restaurants. You know, the the restaurants that are most successful are run by the folks who know how each aspect of a restaurant works. Like I've washed the dishes, I've made the food, I've served the food, I've received the food. You know, it's it doesn't work if you don't like, you know, you can't run a successful business if you don't know how how each part works. >> Totally. >> And I think that goes for healthcare and school systems. >> Yeah. So like breaking down silos like within an organization. >> Yeah. I think that's why having boards is such an important thing whether that's like a board of directors or advisory boards like having if if if we can't necessarily expect one person to have the experience of all of those different positions um having bringing all those people together to kind of mutually make make those decisions. Totally like one of the most valuable aspects of having a you know a board of directors and an advisory board is like the questions people ask. You're like why are you doing it that way or like have you thought of this? It's just the idea of like lots of brains bringing lots of perspectives and lots of like individual zones of genius that all contribute in the most beneficial way to the whole community. Lizzie, what's coming up for you? Yeah, I've been thinking a lot about access needs and how I feel like our team and our model that's a pretty um centralized focus of where we start about like what are our teams access needs, what are our provers access needs, the staff's access needs and then um also we look at what our our patients access needs and getting feedback from them. We're kind of building this ship all together. Um, like with all of our brains working together and also working through conflicting axis needs and things like that, I don't think that the traditional models um really start in that spot. And um yeah, and also we look at our team and realize that it's not all about productivity and just grinding yourself down every day. That that isn't sustainable. So what system can we create for the long term >> for everyone? Yeah. It's almost like when you think about the beginning like the beginning of being a team. Um, so like 2023, right? So like what did we do? The first thing we did was we like we wrote our employee handbook together, right? Like that was that was really cool of like the really unique like so like beginning with access needs also beginning with culture. I don't know that that I mean also I've never been part of a startup before so I don't know if it's like unique to our healthcare environment versus like the opportunity to like start fresh like can you start fresh at any time or can you only start fresh at the very beginning and you like want to do it well I don't know I was just thinking about that too Mel because I like I think all of us have started at a little bit different times times in the organization, but all all of us has kind of been here like you were saying Mel in this like startup phase of like creating a lot of this stuff. So, we've all been here for creating the employee handbook and creating processes and that type of stuff. And I wonder I guess I wonder how different that is to somebody coming in newly into a role where that's already been created because it's not a startup. We're not starting from scratch. Um, >> we should ask Reagan, >> right? Like that would be like that that'd be a really interesting future brain club, right? Because like we have systems. They work in a certain way. And like yes, we I but I think that like part of the system that we created is to Lizz's point, it's still oriented around access needs, which is very individualized. So like the predictable system is to be individualized according to someone's access needs. and to be like invited to reflect the most access needs. Like that's what I I mean it'd be interesting to see what Reagan would say. >> And I think that's another component that we have too of when we reflect on our access needs, we see does the system need to shift at all any of our systems. And I think that's pretty unique too that other organizations the systems typically don't shift as easily or as fast based on fluctuating or different access needs, right? And like some of that is intentionally staying small. Like I don't want to be a health network. I I have no I have no interest in that because I I want to at any given time I want to be able to like change a workflow or like shut it all down because I think to Olivia's point like our staff having our access needs is actually the most important thing to me and like that like so it's inevitable you know we care about patient access needs we care about staff access needs and it is inevitable that those are going to conflict and we're going to transparently name those things like I have the kind of brain that I cannot have the phone ringing while I'm seeing patients and like it's it's always been that way and so the phone does not ring. Um, right? Like that's just how it is and I'm not I'm not going to quote compromise on that because it's my job to keep my brain working because because now that I know that as an access need and like I think that's that's okay. Or I was talking with Reagan this morning and she's like, "Well, in kid connections, people are um they're like saying that they are having a hard time connecting with their match." I might edit this out, but like hard time connecting with their match because they're in different time zones. So like, what do I do? Like this is a free community program. We actually do not have capacity to customize the time zone. That's This is a manual thing that a human is doing times 366 sweet little loves. We do not have capacity. We're beyond capacity to do any other filtering. Um so like I think it's okay to name those things. So I think that like the traditional I mean maybe the traditional healthcare environment certainly a lot of like traditional customer serviceoriented businesses around like the customer is always right and we're going to like bend over backwards to please quote the customer and like I think that that is often incompatible with what Olivia has observed around taking care of staff. like the customer i.e. the patient um the patient may like you know they they they may want something that is incompatible with staff access needs and capacity and like we draw a line in the sand. I don't know that that happens everywhere. I I think that um that's part of why all of our job roles have been like co-determined by the organization's needs and the person's like or and and the employees like desires and things that give them dopamine and access needs. and having h having that co-creation process really makes I think employees kind of go through and learn about our access needs and identify them and the organization to really understand the access needs of all it all of its employees to be able to meet them. That makes me think about Olivia, you and I were talking about this before like culturally and I think like we talk about this in trainings for employers, but it's so important that when there is a breakdown, we assume that this relates to unmet access needs, whether that is a a you know, a breakdown with a patient in a communication situation or a breakdown in a task or or whatever. Um, I I I think that's That's a pretty important part of of of culture. Um, you know, when I think about like showing up to other work environments where there's like this persecutory, you know, you dropped the ball and you know, why'd you do that thing and what's wrong with you and like that whole thing is so bad for health and let alone to Lizz's point around like productivity and performance and like all those neuronormative constructs like those things suffer also when you come to a toxic environment. where you're being criticized and made to feel less than. Also thinking about like um like if you've if most of your needs are not met and what might seem extreme to us, somebody asking for something may seem beyond our capacity to take care of, but they're coming from a place of maybe not even having any of their needs met. So what we may be asked for may seem extreme, but to them it's just another one of the things that they're not able to, you know, take care of or have support around, you know, >> totally. And it's always okay to ask for what you need. It just may be the case that we don't have capacity to deliver it, >> right? >> But like that's part of culture, too. >> Are there other like ways of working that you think are important to note? One thing I had written when kind of previewing the prompts for today on the more like providing healthc care aspect was that at this organization I don't feel like my job as a provider is to like provide solutions to people but more to make a team and like mutually create both like treatment plans but also like create the health goals. And that feels very different from what what has been expected of my role as a healthcare provider in other organizations. Um, and and I think that goes to to to our point of what patient centered care looks like, but also like that the the safety and like quality of life of of employees is is a priority of the organization. >> Yeah. And and also patient autonomy is really important to us too. Like it goes both ways. is like if I truly respect patient autonomy, I'm not going to tell you what to do. Like that has always felt really incompatible to me. And that's, you know, it's very like patriarchal. Is that the word? It's it's very patriarchal and like No, that's not the word I want. Um, it's very paternalistic and like feels like you're giving lip service to the idea of patient autonomy and like I really actually respect you to know what's best for you. I'm here as your guide. I'll make some suggestions. We can co-create ways of implementing them, but like it is not my I it's not my job to tell you what to do. And in fact, like it feels gross to tell people what to do and it feels gross when people tell me what to do. But also saying that then it may it may be that they actually would like you to tell them what to do but they're not sure what that is. Right? So it's like creating a space yes of safety where you can explore what your needs are and then that may lead to you making a suggestion which is you know also what the patient needs. But if you're told what to do, what you're it's not done in a safe way, right? I guess that's the that's the key >> because you may actually want I may actually want you to tell me what to do, but if it's not done in a way that feels safe, um then you're going to be shut down. >> That's so interesting. I almost It's interesting like as soon as I said the thing, I realized that like I don't think I really meant the thing that I said. Um because like that what you said is so true and like like Sierra and I we did a group yesterday and like all the people what we did for all the people was we basically gave them a menu of options. You could do this or you could do that and some people depending on like the level of you know depending on the person and whether they you know I thought that they would have capacity for this they maybe got a third choice. Um, and there's options and like I'll give you a suggestion. If this were me, I would do option A. That's why I gave it to you first. Um, if this were me, I would do option A. There are also these things. Take your time and think about it. You don't need to make a decision now. Um, and I'm going to send you I'm going to send you, you know, notes in your format of your choosing and we can talk about it again next time. One of my phrases that I've been finding I'm using almost every visit is um here's the options. How are you feeling? Do you want to decide now? I can decide for you if you'd like or I can send you a bunch more info and we can think about it and either talk more in the future or you can let me know. Um, and so like giving like you're saying Olivia, um, like g making it clear that like you don't have to take on that whole process if you don't want to. I can do some of it. Um, and like make making that clear and giving those options so there's an explicit place where people can ask for help making decisions and that type of stuff. The other thing about just like ways of working is like when I think about things that have completely drained my battery in other settings, namely interacting with the electronic medical record and writing progress notes in the electronic medical record and like all of that which I think is common and there's you know lots of literature that like this ruins people's lives and leads to healthcare provider burnout and lets them you know leads to people quitting health care and all of this. So like that's another way in which we have designed our system differently. We've designed that we you know we we chart in a very flexible system. We chart in different ways. Um we change how we chart depending on you know our need for novelty and dopamine and and and all of that. And I think like the biggest thing and you know when I when I tell people about this and I tell clinicians about this they're like what you're doing what team based not writing that there's multiple [clears throat] people and like the thing is in traditional primary care that happened too you know like Olivia you would start a note right and you'd like you know you'd interview the patient and you put the history that you gathered at the top of the note you put vital signs and then like the provider would then like open up that note you it was team based notew writing, but it wasn't synchronous and it wasn't flexible. So, it's not radical. It just looks really different that, you know, I'm doing a thing and Sierra's doing a thing and Lizzy's doing a thing and Olivia's doing a thing and it reduces the burden on any one person. I think >> the patients are doing part of that too with previsit worms. >> Yes, totally. It is a co-created experience which decreases the burden on everyone and I think leads to patients actually getting their priorities addressed. Yeah. The I think of the previsit form as like a warm handoff. You know, it's like the in between. It's like uh setting setting the provider up for success and setting the patient up for success. I love that. And it like allows for processing time >> and you know just like multiple different ways of communicating >> previsit form. I think that um it also allows for a lot of autonomy like when you decide what you want to share when you want to share it before the appointment and things like that. Um, so that part is like built in to the system too, which I think is really nice. >> Yeah. And like from a clinician's point of view, it also supports my processing time. It supports the information coming in visually, which supports my access needs. And it lets me think about and organize my thoughts and like do some research and do some thinking and make notes for myself so that I go into that appointment prepared. I think I I think I'm a better doctor because I had I knew what people wanted to talk about in advance. I agree. It's such a different experience. And I think the only the only reason that we get so many previsit forms and the only way people are going to fill them out is if there's that transparency of this is why we do it. This is this is why it's helpful for us. This is why we need it. Um this is why we need it for insurance documentation or our access needs or whatever. And that really especially for a group of people who often really need the why to be able to do something. >> In other words, it feels arbitrary. It's like why are you giving me the band that's arbitrary? Because like I think our patients they a lot a lot of our patients I say most of our patients like feel like they are part of a community with us like they want our access needs to be met in the same we want their access needs to be met. Like that's a that's Sounds like we're having some technical difficulties. I fixed it. Sorry. I leaned on a key and it closed the app and then I forgot what app I was in. All right, here we go. This we might be repeating some. So that part is like built in way people are going to fill them out is if there's that transparency of this is why we do it. This is this is why it's helpful for us. This is why we need it. Um this is why we need it for insurance documentation or our access needs or whatever. And that really especially for a group of people who often really need the why to be able to do something. >> In other words, it feels arbitrary. It's like why are you giving demand that's arbitrary? Because like I think our patients they a lot a lot of our patients I say most of our patients like feel like they are part of a community with us like they want our access needs to be met in the same way that we want their access needs to be met. Like that's a that's a total sea change. Like that's a total paradigm shift. like, "Oh, I had no idea that you spend hours writing notes when you're done seeing me." Of course, I want to support that process. like in traditional um health care where you have the provider has 15 minutes to see a patient and I'm thinking about how much goes involved um for us to see each patient you know even like the previsit form review giving the previsit form reviewing the previsit form taking the time to address the previsit form that alone is more than 15 minutes you know um so you know just even thinking about that um the amount of time that each patient gets time and attention in the way we are trying to do things as opposed to a provider in you know a big hospital or a big health care facility where they're like literally 15 minutes 15 minutes 15 minutes and you know no wonder folks are everyone's feeling disconnected and burnt out and not seen or heard. Yes, that's so interesting that you say that because it's almost like just thinking about to Lizz's point about access needs like this idea of the information comes in asynchronously which allows me the flexibility of using that information according to my own access needs. So like I can review a bunch of people's stuff as a batch and organize their information as a batch and you know in a way that like when it was like patient patient patient patient throughout the day there there was no flexibility in terms of when do you read when do you think when do you organize when do you take notes like when do you you know formulate treatment plans like there was no flexibility let alone also chart review. Like I chart review, you know, like six to 12 people at a time and like look up their labs and look up when they last time they had a mamogram and like all that stuff. We've designed for that. Anything else that we haven't talked about that you think is important >> since the pandemic? I mean, when you're told that um safe it's safer not to wear a mask. I mean, basically, we were told that wearing a mask was is the wrong thing to do. So if you're if the you know if if you're being told that and you're already showing up you're you're not showing up because you're told not to trust anybody it's like oh so this is this is the e the easiest thing to do is stay out of out of community out of connection you know and >> the safest thing sometimes. >> Yeah. And now public health is not being tracked or not being monitored. So it's like >> just falling apart >> just collapsing entirely. That's so interesting. I forgot about that. So like 2020 it's like well um we don't really know how CO has spread. So we like you know here are these rules about how you dawn and doth personal protective equipment. Oh but we're not going to give you enough of it. you're going to like ration in your masks and like all this stuff that like for me was the initial breach of trust of like this is a system that doesn't give a [ __ ] about me. And >> now now now we are at a place like Olivia says where you're just being told like no it's fine it's all fine and a lot of folks were getting that message before the pandemic. So the folks that have been getting that pandemic or that information since the beginning of time that you're not important or you're not valued, you know, they're they're already not trusting or not supported. And then the pandemic hits and then there's more folks that are like, "Oh, you don't care about me?" >> Yeah. So like you like and and and like marginalized multiple marginalized people who have this I mean we've like we we've been covering this at brain club around like just historical mistrust of healthcare in particular because of all the bad things that healthcare has done to people. Um and here we are. I remember during the beginning of COVID as a staff nurse, no one on the floor was surprised the hospital was not providing enough PPE. Um it it was very like yeah, this is this is how this is how the systems work. Of course, they don't have enough for staff to reuse them or whatever. I remember going into the hospital and they were like, "You can only use our N95s under these conditions." And I'm like, "It's an airborne illness. I would like N95s under all the conditions." And like, so having to like go figure out how to like get your own N95s, like you know, by N95 to come to the hospital just like it was madness. And like of course that impacts your sense of feeling safe and like as we know you need to be you need to feel safe before you can do anything. And now like society >> all of the people who are marginalized because of disability plus all the other aspects of identity who like are getting the message that you're dispensable. I don't care if you live or die and let it rip. So ways of working, we have universal N95 mandates. Like that's different from traditional healthcare too because we care that you don't get COVID when you come for healthcare. I'm also thinking about um uh how how we reach out to each other in the community about you know even the best way to connect with you. Um, you know, like that can change from day to day for a lot of folks like having access to a phone, having access to internet, having access to even like using your voice, you know, all these things are like on a daily basis and most of the world do not get the opportunity to even have that conversation. >> Yeah. um and how that's how people become disconnected from community and how like get lost in the shuffle, >> right? So, people don't hear from >> readily that we have to figure out ways of bridging those gaps. >> Um and that's, you know, often relating to like if you don't have your basic needs met, you know, >> community feels like a luxury. Mhm. >> Yeah. >> And you then like you don't reach out until you're in crisis. >> And it definitely seems like America American culture on the whole is like you don't trust anybody. So like add that add that to on top of everything else. Like you grow up in a world in a society where your your your thought your neighbors are not your friend and you we're all here only to survive by ourselves and that's you know Yeah. So you're you're not only unlearning, you're like you're just unlearning so much >> when it's safe to unlearn. And like that's a big if. Like especially under times of uncertainty and upheaval like there's that tendency to like withdraw and like hunker down and separate which makes sense and is really hard. Maybe one more thing I might share is like very different here compared with any healthcare environment I've been in is like I genuinely feel like I'm part of our healthcare community. Like I I I feel that and so that translates into so many different things. So, not only is it to Sierra's point about like patients being aware of our access needs as staff and like genuinely wanting to support them in the ways that we support our patients access needs. There's like that and there's just um it lowers the bar lowers the barrier for me to feel like I can be transparent about my access needs. Like I am a human. I am showing up today. I have access needs. I'm showing up with this energy and I am aware of the way that my energy impacts other people and I'm going to own that. And like these are all cultural ways of being in space with other people that I've never seen done in healthcare that I find helpful. Thank you again to Sierra, Lizzy, and Olivia for this conversation. Um, I also really appreciate the comments in the chat with like just lots of examples of conflicting access needs and I think that um I just want to name that, right? Like that's the point the transparency around this is my access need, this is my capacity. So like Albar, I'm seeing your comment that like you have not been provided multiple paths to participation. You have been given one path and that path is not a fit for your access needs and so you are beyond capacity to do that thing in that way. um if there had been multiple paths to participation, there may have been one that that worked. And there's, you know, a couple of other examples in the chat as we've been going. But I think that like to me that really stands out around like capacity based boundaries which are different than preferencebased boundaries, right? Like I don't prefer to, you know, make a phone call to make an appointment. Yeah. Um I am beyond capacity to make that phone call. It's different. It feels different. Um, and so, uh, with that, thank you all so much for being here and thinking about these topics with us. And, um, we look for for those of you who are coming to the the book launch event next week. We'll see you next week. And otherwise, um, regular brain club will resume the week after on Tuesday, September 1st. Thank you everybody. Good night. >> [music] [music]