Latest / The STA Clinician Podcast / Ep.283 'Common Frustrations For MSK Clinicians: Part 4/4'' with Tristen Attenborough

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Ep.283 'Common Frustrations For MSK Clinicians: Part 4/4'' with Tristen Attenborough · The STA Clinician Podcast

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You're listening to the STA Clinician Podcast, connecting clinicians across health,
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the Sports Therapy Association podcast. My name is Matt Phillips,
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creator of runchecklive.com.
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And as always, this episode is being recorded live on the Sports Therapy Association
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YouTube channel and Facebook page at eight o'clock UK time on a Tuesday.
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So anyway, we arrive at the final
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part of this month's focus on common frustrations for MSK clinicians.
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And in it, I will very soon be joined by my special guest,
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Tristan Attenborough of movementpossible.co.uk, who will be discussing how many
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of the frustrations MSK clinicians feel when assessments, diagnoses,
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or outcomes don't go to plan.
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The fact is that it's often not down to lack of skill, but because of unseen
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cognitive biases and judgment noise, shaping our everyday decisions.
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Tristan is the owner of MoveImpossible.co.uk, and as well as being a sports
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therapist, he also has a BSc in psychology and an MSC in pain management.
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But first, I must thank my guests from last week, So in part three,
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that was Ben Cormack of Core Kinetic and Adam Meekins, the sports physio,
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or formerly known as the sports physio.
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They joined me to talk about.
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Frustrations which they come across during their Better Clinician Project CBD
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platform, which included finding good information to trust, uncertainty around
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diagnosis and treatment, not being able to practice the way you want,
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and dealing with other clinicians' erroneous narratives.
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It was a fantastic episode of my heartfelt thanks to Ben and Adam for giving up their time.
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And that is, as I say, episode 283 of the STA Clinician Podcast,
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available as always on YouTube and all popular podcast apps.
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Don't forget, if you have joined us live, people are coming through now so it seems
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to have opened up a connection then do feel free to ask questions it's gonna
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be a fantastic episode i've left them down there for long enough so let's bring
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up for tonight's episode cognitive biases and judgment noise with my special
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guest tristan attenborough tristan hayden very well.
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Yes we had such a lovely conversation didn't we about everything's going swimmingly
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fine and and and we've had a few technical problems but
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it seems like we're okay so thank you for your patience
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as well as everybody who's still joining us okay as
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always for listeners who aren't aware of you and i hopefully there are always
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say it hopefully there are some people who have no idea who you are otherwise
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it's a waste of time could you give us a little summary of your background and
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what you do now on a daily basis right i i think when you look at my cv i'm
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fairly unemployable because I've done a lot of things.
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I did a degree in psychology in the nineties and then I was a software developer, obviously.
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And then I left that and I buggered about, did half a PhD in psychology in visual
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perception, half, which means I don't have a PhD in it.
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Then I did a few other bits, went gardening for a bit. Then in 2014,
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I retrained as a sports and remedial massage therapist.
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And by the time I got to the end of the course and in my first year of practice,
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I thought, I think I might have been taught a lot of things that aren't true.
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And then I did a master's degree in pain management through Cardiff University,
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which was suitably challenging, trying to write the dissertation up in lockdown.
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That's not fun because it's just you and it.
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Fuck all I have to do. it was horrible and getting that done was one of the
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hardest things i've ever done,
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and then i came out of that and after i got to
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know mike grice and then ended up doing his rather
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fantastic movement therapy diploma which i've
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just about finished up and have recently qualified as a
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sports therapist as well so quite believe that and i like to write talks i've
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done quite a lot quite a lot of talks at therapy expo and a few other places
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i really enjoy it that's me now and yeah i run my own gimmick from my own house
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in northamptonshire in the south south north ants,
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Quite near Silverstone for people who are into that as well. Say again, Sway?
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Quite near Silverstone, actually, if people are... I love it very much.
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Fantastic. That's so inclusive.
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Anybody, if you're into... Silverstone is racing, isn't it? Yeah.
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Cars, brilliant. So if you're into that, then that's just around the corner
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from there. It's just around the corner.
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Fantastic. Right. Well, thank you again for giving up your time.
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As a lot of people will know you because of the presentation you've done at Therapy Expo,
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now called Therapy Show, and also you've got some stuff coming up on the Sports
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Therapy Association local conferences as well coming up, which is very exciting,
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which we'll mention at the end.
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And you were at Ana Maria's Exmouth conference as well, which was wonderful.
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So yeah, a few people have heard you, but I'm hoping that a lot of people who
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are listening who tune in haven't heard you because yeah, cognitive biases and judgment noise.
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I purposely put that in the, as a title because it, they are scary words,
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but the beautiful thing about you,
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one of the beautiful things about you, apart from your hugs and your shirt taste,
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is that you managed to you know make these kind of scary language much simpler
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and and help therapists in particular understand what they're about so i guess
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we should start off really is what is cognitive bias and judgment noise what are they.
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There'll be a slight pause as
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just yeah i think i was going to start somewhere else that's all right um,
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It turns out that we don't naturally think particularly rationally or logically.
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We tend to think on the spot quite rapidly in a way that's quite different from
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when we sit down quietly, have a good long think, or chat things over with someone else.
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And there's quite a distinct gap between those two modes of thinking,
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if you like, slow and quick thinking, and sometimes referred to
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but what's amazing is that there
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are very consistent predictable errors
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that we make and they are robust
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there are something like 200 cognitive biases
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that have been identified and the
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good news is they apply to all of us we all
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do them just as being so it's diagnosis human this is
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why we're all going to be nice and comfortable with this it's okay it's
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all okay so i'll probably
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come to noise a bit later okay that's fine easier to
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jump on that once we've got our heads around this but i
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think can i come at this from a slightly different direction whatever you feel
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yeah whatever you feel like to warm because it's kind of how i play out the
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the full talk which which is the one i did in eczema and i really like to start
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with optical illusions and talk about perception, in this case, visual perception.
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Because optical illusions, they're not realistic representations of what we
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see. They're a reduced, sort of more impoverished image.
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And what they show up very readily is that...
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Our perception is not simply the world is going into our heads and then we see what it is.
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It's nothing like that at all. It's a much more complex two-way process where
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information is going in, but at the same time, the brain is almost reaching
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out, trying to find certain things.
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So optical illusions will demonstrate that because it realizes,
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oh, hang on, you're active in this.
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There's something going on. So it's called, or certainly from quite a long time
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ago, it was called the difference between bottom-up processing,
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which would be your eye all the way to your brain, and top-down processing,
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which is the brain sort of anticipating what might be coming.
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And there are later sort of iterations of this process. But that's what happens.
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So it leads quite nicely into sort of perceptual errors that we tend to make.
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And there's a subset of those called apophenia. and
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one we might recognize is called a
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clustering illusion now what that is is when
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we see something random or a
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pattern that is genuinely random we will tend to perceive
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it as having clusters we we
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think it's we think it's not random and the
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the brilliant example of that i remember when i was eternal student i was also
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a sainsbury's baker did that for years and right in the early days of when the
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national lottery first started i remember when we had the first triple rollover
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because you actually talk to people about it because it was a bit of a bus at the time.
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And i remember the numbers came out and i went to work on sunday and my boss
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in the bakery said yeah it's fixed and he was absolutely convinced because when
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he looked at the numbers they kind of looked they were a bunched together but
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it turns out that things that are genuinely random to our eyes,
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appear bunched together. I mean, we can't actually perceive random.
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And another fun one on that note is that...
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The shuffle function on your iPod, as was, or your phone, plays songs that you own randomly.
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And they started getting lots of feedback and complaints saying,
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I've been listening to this for a while. It's not actually random.
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But actually it was. And Apple had to make the function less random so it would appear random.
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Now, I like things like this because it just starts to unhinge a little bit,
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what's going on in reality and what we perceive as
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going on and i just think that's a very important place to start so the
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world broadly speaking isn't as
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we see it and that's the one we're trying to navigate that's
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really useful so so i think that's really useful that we're
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not talking about faults because if it's
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there it's their design for a reason
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isn't it i guess these are like shortcuts and in everyday life it can help it
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can help us cross the road properly and imagine what's going on without getting
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run over and not having to see everything and kind of like you say make these
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clusters so that's the first thing for listeners to take away what we're highlighting
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here is is it's not faults everyone's got them oh yes about knowing you've got them.
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Brilliant okay yeah i'm i'm intrigued continue okay
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so now the third one and this is gonna this is gonna speak to this
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is gonna speak to massage quite directly is a third
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apophenia perceptual error is uh
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is called pareidolia which i think you
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might have heard of matt pareidolia is your
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brain making patterns out of ambiguous shapes
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the classic being seeing faces in
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clouds and of course when you do that if you
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notice how it works you're not consciously doing it you're not deciding well
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there's the eyes there's no it's done it comes into your consciousness it's
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already a face so it's an early perceptual process and you can't switch it off
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and you don't have you don't actually have any control it's not voluntary it just happens and.
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Paul Ingram, with his fabulous site, painscience.com,
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I think gave us a real gift when he sort of got a working hypothesis,
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which is what's going on in massage and in palpation specifically is a sort
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of palpatory pareidolia, that we are perhaps feeling things that aren't there.
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Now, this was extremely useful, I would say, because we sort of know that having
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maybe many of us came from a background where we thought, here's how you feel
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for an adhesion, here's how you feel for a knot, here's how you feel for a tightness.
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Well, it turns out that obviously we haven't found anatomical correlates or
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patho-anatomical entities that tie up with those. It doesn't connect.
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And we've also seen research that shows when
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you objectively measure the stiffness of tissue though
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they don't correlate with the areas that hurt so so
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so we so we're not
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really feeling what's going on but we have this widespread but i can feel it
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and i think what this does is provides a really wonderful way of understanding
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how on earth this happens i think it required explanation and we go well it's
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a form of pareidolia so if you push your hands into something ambiguous,
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like the mushiness of human flesh.
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You are going to infer from that
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whatever beliefs are already
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in you you see what i mean so they are in you not in
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it make sense that's brilliant
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oh good i want to i want to interject to there as well because what i'm doing
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at this because it can be a real sensitive subject because i can imagine now
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a massage therapist going whoa whoa whoa who's this tristan attaboo that i show
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on telling me that i can't feel that one side of the traps of my client feels
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really tight and the other side I feel and it's not.
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So that's quite a kind of slap in the face for some people.
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So how, being a massage therapist yourself, which hopefully will help the massage
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therapist realize this isn't like a physio or one of those people kind of telling
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us we're doing it all wrong,
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but how would you recommend that people get over the initial kind of frustration
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or anger or kind of that challenge? Yeah.
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What would you recommend? Because, you know, it can be a little bit of a slap in the face, can't it?
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It's good you mention that because I hadn't really thought of it in those terms
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because it's been such a long time since I kind of abandoned that thinking myself, you know.
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It doesn't matter what we feel. It matters what the client feels.
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So just keep the dialogue open.
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How does that feel? Is that all right? Is that tender?
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Just keep that dialogue going. Because that's the most accurate information.
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That's the most accurate information you could possibly get.
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Just switch over to that.
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That's really cool. And that can make your life so much easier. Like I said in the notes.
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Yeah. And you'll start, hopefully, if you listen to this and you're thinking,
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oh, but I definitely can feel it.
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The more you think you can feel something, the less you're going to be asking
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the client, what does that feel like?
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And I remember the first few days when I came across this and the client would
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say to me, oh, does it feel tight?
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And I'm like, I can't feel that. It's tightness is your reality.
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I'm asking you, what does it feel like to you? You know? So I know you want
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to ask me that, but once you get over that and start realizing that,
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okay, I'm going to stop believing that I can feel this.
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I'm going to ask the client, how's that feel to you? Because that's gonna give
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you like you say much more valuable information isn't it yeah yeah and i think.
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Yeah that's a nice it's a lovely door that opens isn't it i think it's a good example of where,
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just because we're cutting something out which you've been taught and
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you base your whole identity on because i remember that
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famous kind of oh yeah well mel cash can actually feel a
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hair through the yellow pages that was like for a long time i
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know insult to mel cash but back in the day that was like the equivalent
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of arnie doing certain kind of bicep curls it was like the
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yeah but it's yeah ask the
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client how it feels to them and give them ownership
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give them agency over you know what you do next rather
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than you deciding based on what you think that's great you know
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you go through training and you tend to think you you know everyone
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thinks their teachers are brilliant and you know that's that's a that's
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a bias by the way i'll just say this now this is a bias we see at a time right
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people will very often go online and say oh i'm thinking of doing a course here
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and people will say oh cannot recommend highly enough uppercase letters cannot
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recommend highly enough like but they've had one teacher.
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You cannot recommend highly enough having had one teacher. You need to see a lot of people.
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You have to have lots of teachers to learn anything, right?
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And it's easy to think when you've only had one teacher or one small group of
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teachers that you just assume they're so knowledgeable.
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You know, because we don't know any better. I mean, have you ever seen the website
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of a therapist and they're really talking a lot of crap and all the reviews
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say, great therapist, so knowledgeable.
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Knowledgeable so it was so knowledgeable and you go no there's no a few things you didn't,
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so you tend you know we tend to think someone has a few things we don't they're
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super knowledgeable i think that's a bias of something don't know
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if it's got a name but it's um it's a
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pedestalling type thing isn't it it definitely is yeah
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authority fallacy i just want to
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say here because i like this gary and this is the founder of the sta being
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honest and open and saying gary says i'm writing a list
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of new words i'm learning this evening and that's great that's so
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cool that's what everyone hopefully will do so rather than getting
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angry and thinking you've challenged me write these words down and then in your
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own time process it yeah because you can google them all and you'll get some
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wonderful information on them so thanks gary yeah and i think i think because
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i suppose over the years usually the things that prompts a talk normally comes
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from something that irks,
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And they just build on it and go, well, why is it?
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And I think what I kept encountering is a mentality where people say, I know what works.
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And people would use that as an argument.
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And people would use that in an argument in the face of evidence that might
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say, oh, you know, we just found another study on this.
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This and that and that doesn't appear to be very effective. And people just
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jump up and go, I know what works. I've been doing it 20 years.
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And I thought, let's start writing down all the reasons why you don't know what works.
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And it sort of led to this.
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You can explain it quite, you can explain easily why someone thinks they know what works.
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And i would argue you probably don't
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which is sort of why we have to science because we
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don't enough you when you think about it the whole reason
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randomized controlled trials exist or scientific endeavor
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in that form exists is because we know
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humans can't be relied upon to get
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that's why they're there that's why they're controlled maybe it's because because we're
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we're too fallible on things like
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this so f-a-l-l-a-b-l-e if
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you want to buy that one dan it's not a ph it's an
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f for that one yeah so you you can have
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a you know you can have a scenario where and and you do encounter this story
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i certainly have where somebody has has had an issue a health issue through
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their life and they've gone to various tests they've tried lots of things and
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then they went to therapist X who did a therapy and they got better.
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Now there's loads of reasons why they could have got better.
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There was nothing to do with that therapy, which I should come back to.
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And then sometimes they might decide, oh, I want to learn to be that kind of therapist.
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So they go on the journey. So they go and meet a teacher who also believes in that.
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And then they go and start their own practice and then they treat people.
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Now that whole story can happen And it can also happen with a 100% pseudoscientific therapy.
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The same journey can happen. And I think understanding things like that is humbling.
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And I think we could do with a bit of humbling from time to time.
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So let's put a couple of things together. Mm-hmm.
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That can lead us to getting a little bit lost, a bit confused,
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and a bit, I'm going to say, delusional.
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If you have, let's say, 50,000 people who live in your locale who could potentially
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visit you, well, a certain number of those are going to come and visit you at your clinic.
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So it's a non-random sample.
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So you already have a selection bias that's taken place.
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But also they're coming probably with the belief that you can help and we know
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from some studies that the belief in a positive outcome can be a massive predictor of a good outcome.
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More so than every other i've seen a study where it was the
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most powerful factor so that's very important and then
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of those that come to you some will see
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the process through but you'll lose a few you don't
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know what happens to them because they're gone they're just they're just gone
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so what you have there is missing data if you have missing data you don't have
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the whole picture so then we go another step and say okay so this lot see a
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massive improvement and you go yay that's brilliant and they're really pleased
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with you and of those a few of them will write a really nice google review for you.
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So what you've done is, you've now gone through all these stages,
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and we can conclude that reviews are really bad data.
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We rely on them, we need them, because you've got to get your rankings.
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But there's actually a whole set of steps that have blurred the reality.
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So you're seeing, and what you're also seeing is what's called a survivorship
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bias, which I think we did talk about once before, Matt, a long time ago.
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Which is when you're when you're only seeing the survivors and you're not seeing
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the whole picture the whole data then you're you are looking through a skewed
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lens yes so add to that a few other,
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real phenomena that we know about one is we always have to keep this in mind
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is natural history is the natural history of any kind of ache pain pathology or whatever.
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So for example, 80% of novel back pain resolves in something like two to six weeks. Agree with that?
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That means 80% of everyone you've seen with a new back pain would have got better
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without seeing you or doing anything.
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Know that and remember that and know it. It's humbling. It's all right. It's okay.
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We're still doing good work because in fact, a lot of the time we might just
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be giving people reassurance because they're worried. So that's completely, completely valid.
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There is an adjacent statistical phenomenon called regression to the mean,
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which is very similar, but it's slightly different.
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And it simply means if you get a series of data points, when you,
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when you, when you encounter an extreme value, the next value will be closer to the mean.
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So the easiest way to understand that, if you sit on a train platform and watch
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people come off the escalators, well, there'll be different heights.
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There'll be different heights. So a lot of people will be middly heights.
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Odd person will be really tall. The odd person will be really short,
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but you'll see. And then if you get a seven-footer come through,
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what will the next one be?
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Are they more likely to be another seven-footer? Or is it more likely to be closer to the main?
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That will be closer to the main. It's just a phenomenon that happens.
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So if someone's got a 10 out of 10 pain in one day, next day,
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it's probably not going to be that.
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So it's a very similar thing to grass. It overlaps with it.
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Now, add that to all the other stuff I just said, and you are now...
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Witnessing great outcomes but you could be a bit misled does that make sense.
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So in terms of so you've got a happy
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clinician but it's almost like a false happiness
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because on a as a
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financial model you could be doing much better
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if you didn't trust your instincts because a lot of those people you
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think you're doing great but you can actually do a lot better because that's
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what a lot of people probably need to know from this is that what we're
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trying to do is tell you that recognize natural no
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i don't say flaws ways of thinking which don't help you in a
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clinical context which actually
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make your business model a bit weak if you think it's all going wonderful if
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you don't realize that the people who don't come back to you aren't
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getting better by what you're doing then you're never going to challenge what
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you're doing are you going to keep doing that thing and helping
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half the people all the time which is not a great business model
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you know and you try phoning people and they're not picking
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up because or you're only phoning the people who said they were really happy
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so you're not going to change your practice are you so and considering
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that burnout is one of the biggest things which affects you know msk
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clinicians across the board whether it's physios dropping out
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or or sports therapists then we do need to find ways don't we of trying to to
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be honestly happy with what we do which i suppose involves a better way of measuring
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what we're doing and yes because really if you if you stand up and boldly shout,
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I get great results, or I know what works.
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There's so much you haven't controlled for.
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You wouldn't accept a study based on someone's opinion of how well it's going.
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It's just completely, it's completely flawed.
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And of course, a lot of the time, we're not even using any kind of objective measure.
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I mean, we've got a few tools and bits and bowls we can use,
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but a lot of the time, we're not using objective measures.
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So there's a lot of loose threads floating around in there.
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I'll tell you something that was a bit of wisdom I encountered.
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I think this is absolute gold. it was
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in 2020 i watched a
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zoom chat talk with david butler the pub
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scientifique were hosting and it was
25:02
a it was an absolute beauty and he called it something like the seven waves
25:07
of my career or something like that and he was sort of talking about how he
25:12
qualified i think it was in australia and then he came to london and spent a
25:16
few years here and was kind of following a few other trends.
25:21
So I think he did Mulligan, McKenzie, Cyriax, and what was fascinating was as he told the same story.
25:30
And the story was, he learned about it, he realized it was fantastic.
25:34
And he started using it and it was going really well. He got fantastic outcomes with his patients.
25:38
And he said, but after about two years, it stopped working.
25:43
And what was so brilliant, he'd go on to the next one and he told the exact
25:46
same story and the exact same story.
25:49
And I think that is absolute gold because that contains everything because it
25:54
can't be the therapy and it can't be the patients. It's you.
26:00
It's you. You, you will go on believing it. Do you see what I mean?
26:06
I think simply just by being, you know, diagnosis human, which is all right.
26:11
We're going to be, we're going to be fine with this.
26:14
In this kind of practice, in this environment, where we can easily become quite
26:21
self-deluded. All right?
26:24
And I think that's important. So I'm jumping in now. Please do.
26:30
Because you've studied psychology a lot, and people who read about it will see
26:33
the word like deluded and not take insult.
26:37
Okay, fair point. No, I'm just thinking of if you say to use that in everyday
26:41
language, like, hi, massage therapist, you realize you're deluded.
26:43
They're going to go you're just calling me like um i've got some kind of but
26:47
deluded is is an innocent word it's an actual word if it's used it just means
26:51
that you you've talked yourself into something that's not true which is what
26:55
we're talking about isn't it so yeah i just wanted to say that we're not we're
26:58
not brilliant point yeah it's not something i would remember to,
27:02
no i think it's just useful it's tricky isn't it because yeah so yeah sorry
27:07
i interrupted again but Yeah, it is delusion.
27:10
Yeah. So we have these cognitive biases going on, and the most potent of all
27:15
of them is confirmation bias.
27:18
So this, you know, we seek the things that we agree with, that we think are
27:24
true, and not only that, but we remember the things, and we tend to forget.
27:29
I mean, here's one. Just have a little think about all the falling outs or arguments
27:34
you might have had in your life.
27:36
You're probably right in all of them, weren't you?
27:39
Because you tell the story back to yourself from a very one-sided point of view.
27:43
And then sometimes you, I don't know if you've had this, I've had to,
27:46
there are times that I just in recent years where I just have thought about
27:50
some of those times and thought, yeah, I think that was me.
27:56
Yeah. But it takes a while because you tell yourself the story. If you think, yeah,
28:01
If you think, well, Audi drivers, they're all shit, aren't they? They're all dangerous.
28:05
Every time you see one, your brain goes, there's another one.
28:07
Aren't you right and clever and predict everything?
28:10
And every time one that isn't an Audi does it, you kind of don't really clock it.
28:14
You know, this is fine. This is just us. And it's because the whole world and
28:17
everything in it is far too complicated for us to process thoroughly and properly.
28:21
So we have these, we have heuristics, which are sort of mental shortcuts.
28:26
So our running jumps to the answer. It makes life so much. And it's the only way we can function.
28:31
But the good thing about these is, but they are predictable.
28:34
They're robust and they're predictable. So I'll just tell you briefly about
28:38
this other thing called noise.
28:41
Hold on, if you can, if it's all right, I'd like you to do a little bit more
28:44
on confirmation bias because I think that's probably the first one.
28:47
I think it's one of the wonderful ones. If a clinician gets their head around
28:49
it and realizes that they actually do do that, then it just opens the door to
28:54
critical thinking, doesn't it?
28:55
Which essentially is just doubting yourself and being happy to doubt yourself.
28:58
So what's another example of confirmation bias?
29:01
Stereotyping. Okay. Expand, please.
29:04
So stereotyping is when we tend to, we think of attributes around a particular group of people.
29:11
And so you associate attributes to a group.
29:14
And then when you meet somebody from that group, you assume they have those attributes.
29:18
Whether that's an ethnic difference, whether it's a class difference,
29:22
whether it's a gender difference, we stereotype.
29:25
And you kind of have to catch yourself doing it. I didn't mean that.
29:31
You know, we'll, you know, we'll do that.
29:32
And, and you're not evil for doing it.
29:35
If you think it through and stand by it, that's a problem. But,
29:39
but actually a lot of the times we recognize these things and say,
29:42
Oh no, that's a, yeah, I didn't mean to do that. Yeah.
29:45
I didn't, I did think that it's not actually true. It's all right. So that's,
29:50
That's a really good example. I think I love the idea as well as just realising
29:53
that you will do it. It's the way the human brain works.
29:56
It probably, at one stage, it really helped us when we had to beware.
30:02
For our survival as a tribe, if you get attacked by some kind of animal and
30:06
you know that it kills half of your tribe, every time you see something that
30:09
looks a bit like that animal, you're going to think it's going to attack us again.
30:12
Even if that particular animal was just going through a bad day.
30:16
There is a value there, isn't it? You and I talked about tribalism before,
30:21
because it's an interesting point, because I don't think it's wholly a bad thing.
30:25
Tribalism is literally our evolutionary survival. We club together.
30:31
We're safer in numbers. The downside, and it's nice, and you find your tribe
30:37
in the professional community.
30:39
You find people who are kind of like-minded, and it's helpful and supportive.
30:44
At the same time, it's also a bit echo-chambery.
30:48
So it's always a bit of both. And what you tend to find in, in various,
30:53
I guess, groups of thinking, it's actually tends to be more,
30:58
people will often value inclusion in the group.
31:02
Over accuracy of information and that
31:07
prevails so when you sort of and you certainly see that when you see
31:09
more radical thinking online and it's the
31:12
inclusion in the group rather than actually trying to seek truth
31:15
together you know what i mean so so so things like
31:18
tribalism is a very interesting sort of area but it
31:20
comes with with good and bad it's not inherently bad it's
31:24
just a bit of both like all these things so
31:27
yeah should we should we um i gave
31:29
you a slide can we put the slide up oh sure yeah yeah
31:33
let me find that we love a slide um let me just bring it
31:35
up i think it's going to be i really want a
31:38
few people would just to comment please and
31:42
i promise i'm not going to humiliate anyone that's not the point of this
31:45
at all i have a series of number his
31:47
numbers here and i'd like anyone to please take some guest shots of
31:50
what the next number is will this work if someone's listening to a podcast
31:53
did i read out the numbers and then what it says underneath will it work without
31:56
the visual yes okay so if he's the podcast
31:59
and what we've got here is a white screen at the top in large font
32:02
you've got one two four eight sixteen.
32:06
Question mark okay so one two four eight
32:09
sixteen question mark and underneath you have two questions what
32:13
is the next number and what is the rule yep
32:16
it's a two-part question i'd like anyone please
32:20
please step forward just to throw in a
32:22
number people joined us live this is
32:25
your chance okay you want to see some honest thing unless you've seen it before
32:28
you know the answer and you know there's actually a gorilla running across the
32:30
screen or something but it's not that this is the wrong one yeah let's have
32:34
some answers in there what do you think nikki mansfield is 27 excellent nikki
32:39
would you like to have a hazard at what the rule is.
32:44
Nicky can come back with what you think the rule is. Leslie Campbell said 18,
32:47
question mark, question mark.
32:50
Maybe same question to Leslie. I guess what do you think the rule is then?
32:53
And if you listen to the podcast, then write down a few possibilities yourself
32:57
because the answer will be coming up very soon.
32:59
Okay, so 21, just to fill you in, 21 does fit the rule.
33:05
18 also fits the rule. Any more guesses?
33:09
Can I say what I'm thinking? Because I've only got one answer,
33:12
And honestly, even though I know you've got a trick up your sleeve,
33:15
oh, not a trick, that's wrong.
33:16
But for me, logically, it's got to be 32.
33:21
Okay, Matt. And for me, that's the only rule I can see, because you're just
33:25
doubling each time. R equals 2.
33:27
Okay, so you're going to say 32.
33:30
Say, yes, that does also fit my rule. Okay. So my second question in that, what is the rule?
33:38
R equals 2. They're just doubling each time. That's not the rule.
33:42
Oh, I really, I've got the right answer. If you remember, we've already had 21 and 18.
33:46
They also hit the rule. Maddening, isn't it? The rule is, says Leslie Campbell,
33:51
the rule is it looks nice.
33:54
Winner. And that's the end of the show. Thank you for joining us tonight. That's number wang.
34:02
Oh, interesting. Nicky Mansford says, number plus two more than the last number
34:06
you added. Is not the rule.
34:10
You're only going to crack this. By guessing more numbers. Gary says 24, 32 also fit the rule.
34:18
24, 32 also do fit the rule, Gary. Yes. Any idea what the rule is, Gary?
34:24
Does 32 and 64 fit the rule? Yes. Okay.
34:30
Right because this is a podcast we're gonna have to to jump to what's going
34:33
on here right then matt i'm really
34:36
intrigued i need to guess a number matt five guess a number matt five,
34:41
five okay five five doesn't fit
34:43
the rule okay yeah i
34:46
wouldn't think it would why i did
34:49
my brain can't create a context in which i
34:52
can see that one doubles two and two doubles to four but all
34:56
right here's the here's here's the rule the rule
34:59
is the net the number is higher
35:02
than the previous number oh shut up that's the end of the show people
35:05
go away now here's the interesting part you can only crack it if you say a number
35:12
that's lower than 16 like you'll never get it because you'll go numbers numbers
35:15
numbers it goes on goes on all day long and no one ever works out the rule until
35:19
somebody accidentally says a lower number and once they realize a lower number doesn't fit,
35:25
then somebody gets it somebody will crack it you go oh is it just that they
35:28
get higher you with me can I explain that again yeah I get that yeah,
35:35
that's kind of the umbrella is the number's going to be higher but there's plenty of ways of making it.
35:41
Particular number that yeah okay keep going
35:44
okay the point is somewhere
35:48
you have everyone who does this will
35:51
have the assumption that they are going higher
35:54
and we tend not to ask the questions that challenge
35:57
the assumption oh we ask the questions
36:00
that support our own assumptions even when
36:03
we don't know there are assumptions got it okay yeah
36:07
i like that yeah so that's a little exercise in confirmation bias so what i
36:13
would say is in my head i think that can tell us quite a lot about clinical
36:18
reasoning because i think to to circle back to what the series is about,
36:24
one of the most frustrating things i think is that clinical reasoning is exceptionally
36:31
difficult to do because i don't think our brains are naturally wired to do it
36:35
i think is it it got because what we will tend to do is have a working hypothesis,
36:43
where you're going, whoa, whoa, but this is patellar tendinopathy.
36:46
Something's already gone off in your head. You've got an idea.
36:49
And what do you do? Well, what you tend to do is you'll then start testing for
36:53
patellar tendinopathy.
36:55
Because in fact, what you're supposed to do is try and disprove it.
37:00
And then if you fail to disprove it, then it's more likely to be the case.
37:04
Or in so doing, you're also more likely to pick up on something else it might
37:07
be. Do you see what I mean?
37:10
Yeah. So clinical reasoning is just inherently difficult for us people.
37:15
And that's a frustration.
37:17
That's a frustration I feel. And I have some potential...
37:24
Antidotes I'd like to share that I've got up with because it's hard to reckon
37:31
with these things because these are peopley things and we're people.
37:34
And I truly believe the first and most important thing we can all do from today
37:40
going forwards is never take credit for a good outcome.
37:44
I think it's it's
37:48
the first step in the path to self-delusion when you
37:51
start thinking it's you you're buggered
37:54
because there are so many other reasons just
37:58
biologically phenomenally and
38:01
in terms of all our own biases as to
38:04
why something got better so just take yourself
38:07
out and go i'm really glad that's got better i'll
38:11
give you a fun example of that years ago
38:15
i saw it was my mates dad and he came to
38:17
see him with a little bit of an achy pain and while he
38:21
was in the session he said he'd actually had a pain in his intercostals for
38:24
about 10 years following a pulmonary embolism which had obviously long been
38:29
cleared up but he was left with this wee pain i thought while we're there we'll
38:33
just go through it well it went one session gone now the biggest mistake i could make,
38:39
is to go whoa these god hands i can fix anything it's not just go i don't know,
38:46
Don't know why that happened.
38:48
Great result though. Brilliant. Pleased with that. I'm all right with that.
38:51
Really comfortable with that. Just you to me.
38:54
So I do think the first thing we should do is just don't take credit because
38:58
we're going to skew ourselves.
39:01
I think the second thing we can do is when you write up your notes,
39:06
at the end of it, put a little section called reflection.
39:11
So this is the bit that, I mean, I tend to do my notes either in the evening
39:15
on the sofa or first thing in the morning on the sofa. So I'm completely relaxed.
39:18
And I think it all through. And this is a chance just to really go,
39:22
ah, did I get everything right?
39:24
What could I have said? What else could I have asked?
39:27
Ah, then you think of something else. Ah, I didn't test for that. Do you know what I mean?
39:31
Because you need to bring the things that don't confirm what you were thinking
39:36
into the light and make it a habit.
39:38
So every time you write your notes up you write the bit where you question what you did.
39:44
Helpfully don't beat yourself up don't do that it's all a positive
39:47
experience okay what else
39:50
could I have done or how could I have done this or what have I missed and
39:53
sit and then look something up and you go right or even right I'm
39:56
going to go and look this up because I've forgotten how to test for that it doesn't
39:59
matter I think if it's a habit it then brings
40:03
that aspect of thinking into your clinic to
40:06
practice i would argue third one i'm going
40:08
to relate right back to two weeks ago when he had emily
40:11
on and she made the point that really
40:15
it's probably good practice to have some kind
40:18
of mentor or supervisor and a formalized if
40:22
you're working on your own if you're not in a clinic where
40:25
you can tap people up having that and i would suggest that
40:28
over anything on facebook because that's
40:31
not a good place to be getting information for your profession for so many so
40:36
many reasons and i think what we want to aim for and aspire to is to have confidence
40:42
with humility and i think it's the two together that makes us gives us the best
40:49
chance of being good practitioners.
40:53
That's good yeah humility is a lovely word yeah it's a classic humility i mean
40:57
it's nothing new this we were taught by the greats kind of 400 years bce but
41:01
it's but it's healthcare,
41:05
healthcare turns us a little bit into monsters isn't it the training
41:08
we have it's just the system isn't it because we are
41:12
most courses and if you if you're listening live and
41:15
maybe challenge this but most traditional courses they do
41:18
build us up don't they to be the fixer to
41:21
be the god the person on the pedestal in
41:23
the white coat fixes everything and that's so not
41:26
what it needs to be and that just opens the door
41:29
to all of these biases doesn't it because we've got that pressure i think
41:32
more i would argue more so in in our field i would say more so in in in the
41:37
massage therapy world oh i include that in msk health yeah no i would i would
41:41
i think i would think it's even more so i might be yeah but my guess would be
41:45
and actually probably even more so than there are quite a lot of CPD weekends.
41:50
A lot of CPD isn't good.
41:54
I think it tends to embolden people. You get all built up because you've got
41:58
someone, again, who you think is an absolute expert, but it might be that they've
42:01
just got a bit of a personality.
42:03
People, I think, can leave those with raging overconfidence.
42:07
Whereas, in actual fact, I think the exercise of trying to get better clinically
42:11
is an always humbling one. As long as you're always in contact with somebody
42:14
who's a lot smarter than you,
42:17
That keeps your feet on the ground. Even I think somebody who's much smarter
42:21
than you, like a mentor or something, if they're a good mentor,
42:24
then probably they're going to just encourage you to listen to yourself.
42:30
And listen to yourself again until you finally go, oh yeah, what are the chances
42:34
of the next five people after that course all having the same problem that I
42:40
learned how to fix on the course?
42:41
Do you know what? And eventually they'll go, oh yeah, that was confirmation bias, wasn't it?
42:44
And and then that's that's what you need isn't it
42:47
someone to tell you to listen to yourself i i had
42:50
it in mind the other day to mention exactly that that's fantastic that
42:54
that's exactly what happens you'll go on cbd you'll
42:57
see them that week yeah yeah it does happen the
43:00
same as you you know you think true no it
43:04
can't be you know i used to get so confused probably
43:07
for two decades on confirmation bias and
43:10
i was convinced that something else going on and i'm still you
43:13
know as i say i'm still a little bit like the universe is a
43:16
donut shape or something and it's coming back and bouncing on itself i wouldn't
43:19
be surprised if someone says no it is because if i hear
43:22
a rod stewart song on the radio in the morning and then suddenly i
43:25
walk past by someone in the bus stop who's dressed like rod stewart
43:28
and then i see a poster rod stewart on it i'm going something's
43:31
going on here something in the universe wants me to see
43:34
these rod stewart or something like that you know and i
43:37
know it can be explained by confirmation bias but it's it's
43:40
because it's every cell in our body is telling
43:43
us that something's going on but we just because we
43:46
don't we're not able to process the fact that we missed the person who looked
43:50
like kenny everett or we missed the person who looks like bruce forsyth or we
43:53
missed the song on the radio which wasn't rod stewart you know we're only looking
43:57
for confirmation of what we think it's a bit like we've all had the experience
44:03
where the you know the phone goes you go i was thinking about you today.
44:06
That's a common experience. And again, you just approach it scientifically and go, well.
44:12
How many people did you also think of who didn't clone today?
44:15
Suddenly it bounces down to a, oh, that actually could happen anyway.
44:18
You know what I mean? It's the sort of thing, you know, good science degree.
44:23
I think it's quite relaxing when you realize it, when you think back and go,
44:26
I was just about to say that. We must be telepathic.
44:29
But in the context where you've just finished a conversation about money and
44:33
then someone's just said five
44:35
pounds for a burger, you're both going to go five pounds for a burger.
44:38
That's terrible. And you both say it and you go, wow, we've got something going
44:40
on here. Have you heard of Occam's Razor? Yes.
44:45
Yes. So it's a philosophical argument tool, isn't it? And it's often slightly misunderstood.
44:54
It's the argument with the fewest assumptions as the one that's most likely
44:59
to be right. Very helpful.
45:01
Sometimes it's interpreted as the simplest one. It's not necessarily the simplest.
45:05
It's the one with the fewest assumptions.
45:08
So, so when you see something in the sky and go, oh no, you know,
45:11
if you're scientific and you can't explain it, you'll go, oh, that's weird.
45:15
And if you're not, you'll go, I know what that is. It's aliens.
45:19
Yeah, yeah, yeah. Very different way. So.
45:23
Fascinating, mate. Really cool. We're just basically, I think that the whole
45:27
of this thing and everything you beautifully talked about is just getting people
45:30
happy to question themselves and follow science.
45:32
And science has this thing where it forms a hypothesis and then it does everything
45:36
it can to see how that hypothesis might not be true.
45:40
It does all the tests possible to disprove what you're assuming is right.
45:44
And if we just start accepting and doing that, then I think a lot of these biases
45:47
will disappear because you think, right, what I've done here has fixed this person's Achilles.
45:52
I've been doing Cyriax or whatever on it. And that's definitely how it's worked.
45:56
And then you start thinking, right, what else could it be?
45:58
Oh, they've stopped running this week as well. Oh, they've stopped wearing those shoes.
46:03
Suddenly i mean you think i like to think that you know you said you know you
46:06
said the outcome is not to do with you and what you've done it might not be
46:11
it might not be yeah yeah i think that's probably the case if everything you've
46:16
done if you're if you're using that to explain what you've done to the person but if you have.
46:24
Had a consultation where you have listened to the
46:26
person and allowed them to explore what could be going on
46:29
and they've made suggestions and they've realized that
46:32
they've got to sort this out because they're not sleeping well and
46:35
that's the only bit then you can still kind of say
46:38
that was down to me can't you it's just it's not what
46:40
you've done to the person so you can be really successful therapist
46:43
and congratulate yourself every day as long as
46:46
you're not just going down the road of trying to fix somebody with
46:49
a modality I mean sometimes modality might help but normally
46:52
it's going to be listening to your patient and
46:55
letting them work through what's going on yeah i think i
46:58
suppose it's it's i maybe i have a mentality that almost sort of says you know
47:02
deconstruct yourself tear it down and then the truth will emerge um but it's
47:08
not you know you're not going to get right the weirdest thing about the cognitive
47:12
biases is and i say there are at least 200 documented ones,
47:17
you can't get around them.
47:20
They are part of you, right? They will happen. And there's even a fallacy called
47:25
the GI Joe fallacy, which is the belief that if you know about these fallacies, we'll overcome them.
47:32
Oh, that's good. That's a real pain in the ass because knowing about them is
47:36
not, is not half the battle. It really isn't.
47:39
So you've actually got to sort of try to mitigate where you can. Yeah.
47:44
And so this is why I personally like the idea of writing reflective notes in
47:51
a quiet moment by myself, because I can start to think, okay,
47:56
so this is everything I thought on the spot,
48:00
and this is me stopping and slowing down and having a think through.
48:03
And then you can ask yourself more difficult questions. So, you know, it's a habit.
48:08
So you don't get around cognitive biases you can't get rid of them they're your
48:14
brain it's what a brain does.
48:17
But to to help you in doing what
48:21
you do i think there are little practices that will help and i do think there's
48:24
a lot to be said for just holding things lightly you know not using absolutes
48:31
because as you know only the sith deal in absolutes so don't be absolutes about everything just allow,
48:40
flexibility in what you say.
48:45
Be looser, hold things lightly. And it gives you, it actually,
48:49
that gives you more wriggle room,
48:51
to think and you go, you know, we might be this, we might be that.
48:55
Don't know, be all right with that. So hold, hold it lightly and be patient with yourself.
49:02
And, and I think with that, we can cultivate confidence with humility.
49:07
It's got to be with humility.
49:09
That's really good. Otherwise you're a pain. Excellent. Yeah.
49:13
Changing the language you use. Yeah, it could be. Yeah, maybe.
49:15
Yeah, it's totally possible.
49:17
Avoid the absolutes, like you say. Really cool.
49:21
Wonderful amazing gary here just bring up a few notes
49:24
thank you everybody's put messages in here gary benson founder of the
49:26
sta says sta members can access supervisory support of
49:29
our coffee evening chats or accountability sessions details in these
49:32
letters and members group featured posts yeah definitely especially
49:35
if you're a solo clinician working by yourself then reach out
49:38
to others and if that person just going yeah yeah you're right
49:40
yeah it sounds like it must be and it's they sound very supportive but
49:44
really if you've got a good listener then they should just be allowing
49:47
you to hear yourself and just repeating things and maybe just
49:49
challenging it a little bit a little bit of devil's advocate sort of thing you
49:53
need somebody like that to think things through um stevie
49:56
bar i think he's got a wonderful example here of confirmation bias i used a
50:00
song i was gonna do a scottish accent i won't do it i used a song for a fitness
50:03
class old and 80s fav of mine haven't heard it on the radio for years heard
50:08
it the very next day i used it yeah wow what are the chances steve see that's
50:12
the ends of the universe curling around each other again.
50:16
Maybe. I don't know. I'm not saying it wasn't, but yeah, yeah. That's good, Stevie.
50:20
There's loads of examples of this. Yeah, seeing 10, you buy a car and suddenly
50:23
every one of those got that same car.
50:25
It's beautiful. It's comedy is the wrong word, but it's warming.
50:30
I think it's satisfying when you realize our brains work this way.
50:33
It makes you beat up yourself far less because you realize it just makes it
50:37
fun. I did it a fortnight ago. I did it a fortnight ago. I read about a pathology.
50:41
Two days later, bugger me, I found one. First time at Found one.
50:46
And then I went back and thought about it.
50:48
And realized that I did actually know the pathology. I just knew it by a different name.
50:53
And then I did some more tests on the person next time I saw them,
50:55
and it wasn't there. Oh, really?
50:58
That was two weeks ago. I know full well.
51:03
Yeah, yeah. When you see it tomorrow, it's probably not.
51:08
It's all right. It's all right. It's all right. Very nice.
51:12
Leslie Campbell here says, I like this to read it out for podcast listeners.
51:16
I like to congratulate my clients when they feel better after a session. I say, well done.
51:21
There you go. Humility in its essence, in the wonderful form of Leslie Campbell.
51:25
Yeah, just thank your patient more. Just literally, and be honest about it.
51:30
Praise them for what's happened in the time you spend with them as opposed to
51:33
focusing on what you've done.
51:35
And you'll be far more effective therapist. Wonderful.
51:39
Right, okay, look, it's 9.03. So, fantastic.
51:43
I want to mention, I'm still not very happy about that. We'll have a chat about
51:46
that later. I want to draw attention to next week. Next week will be May.
51:51
So we're going to start a new focus. We've reached the end of frustrations for MSK clinicians.
51:56
And we're going to move over to communication skills for MSK clinicians,
52:00
which I think is quite a nice follow on from this, because if you understand
52:03
how you work being a human being, then it very much challenges people.
52:08
Whether you are actually as good a listener as you thought you were.
52:11
Obviously, if you're listening, you've got confirmation biases,
52:13
it doesn't matter how much you pause and look at them and smile.
52:16
If you're thinking in your head, I know what you got, I know what you got when
52:18
you walked in with that limp, then you're not listening to the patient and it's
52:22
not going to work. So really nice segue.
52:24
I'm double excited. I mean, obviously I love communication skills from MSK clinicians.
52:28
I've got my course and everything about that, but I'm really excited because
52:31
my first guest of the month next Tuesday is going to be Orla Adams.
52:35
If you are into motivational interviewing, than Orla Adams is a name I'm sure
52:38
most of you have come across.
52:40
She is a trainer with co-founder of Motivational Interviewing,
52:44
Stephen Rolnick in Cardiff.
52:46
So she is, yeah, on the coalface, absolutely a Motivational Interviewing and
52:50
a wonderful person as well.
52:51
She's been delivering MI training since 2009 to a load of different disciplines,
52:56
including doctors and physios, sports therapists, sports coaches,
52:59
dietitians, community sport workers, so across healthcare. and she's a fantastic educator.
53:05
It'll be a really nice entry point both to people who aren't quite sure what
53:09
motivational interviewing is about and also to people who are familiar with
53:12
MI and just want to see it in practice and hear about how it can be applied to MSK Healthcare.
53:17
So really excited about that. And then the next three Tuesdays or maybe a Wednesday
53:21
or something in the month will have other aspects around communication skills
53:25
for MSK clinicians as well. So that's going to be really exciting.
53:28
Please join us live next week if you can. apologies if
53:31
this youtube feed didn't work tonight fortunately it's
53:34
only seven times in 283 weeks so i'm
53:38
not going to use confirmation bias and think it breaks all the time because that would
53:40
be ridiculous but it does feel like it but anyway
53:43
yeah so do join us if you can it'd be a wonderful opportunity to ask our guests
53:46
questions directly but for now yeah i just want to thank once more not take
53:51
the spotlight away from the marvelous tristan attenborough of movement possible.co.uk
53:55
what have you got coming up uh tristan anything interesting or tell me about
53:58
yeah you've got the STA conferences?
54:01
Yes. There's two. I'm actually speaking of both of them, different talks. May the 9th in Dorset.
54:08
I know, honestly, people should get along to that one. It's really, I don't know where this,
54:12
I think it's $55, $60, but it's cheap and it's all day.
54:16
And it's just a lovely, friendly, inclusive day. And last went last year and,
54:20
and it's, and we all had lunch outside and it was just a nice way to meet people and have nice chats.
54:26
Uh, so Alex Moore is hosting that.
54:30
And I'm talking about actually being proud about being a massage therapist.
54:34
Nice. Because I think we keep getting it wrong and we don't need to. We can get it right.
54:39
And another one again in June that Mike Grice is hosting, which is the Ludlow.
54:45
So that's the Midlands Regional SDA Conference.
54:48
Fantastic. Okay. So we'll make sure links to that are available in the show
54:53
notes. So affordable. Too affordable.
54:56
But yeah, very affordable. but yeah great chance to network
54:59
and and mix with some really nice people and great speakers as
55:02
well so make sure that goes in the notes and anything
55:05
else in your life going on you want to kind of mention about you got
55:08
any courses or anything yourself yet or is it still just work work
55:11
and helping people change lives yeah yeah yeah just about yeah now just just
55:16
gonna dial things back a little bit just enjoy job fantastic enjoy life a bit
55:22
i mean if people want to follow you then you've got the website moveimpossible.co.uk and also on Instagram.
55:30
Moveimpossible yeah same thing yeah and Facebook so people can see because you
55:36
do post now and again don't you you've got some interesting I mean it seems
55:38
like the only other day you said massage was a luxury so that spurred this whole
55:42
month I don't know if you want to say anything about that or,
55:45
sorry did you want to comment on that at all because we've spent kind of two
55:49
or three weeks quoting it but I don't know I think we're I think we're a professionally
55:57
insecure group of people.
56:00
And these aren't things we need to worry about. I got a whole list of things
56:03
we should be irked about.
56:05
Every time I look on social media, I've left most of the massage therapy Facebook
56:09
groups because they seem to be getting worse.
56:13
I think more people are coming along with training that is frighteningly lacking.
56:19
And a lot of people who are answering questions are very confident and very
56:22
wrong. and I think quite a lot of us have had enough and we're just not arguing
56:26
anymore which isn't a good sign is it?
56:29
Could it be that the source of your information of people joining a Facebook
56:33
group is not a good representation of...
56:37
No, I've always agreed with that. I've always agreed with that point.
56:40
But at the same time, these are real therapists. Yeah, and it's true.
56:44
They are out there working with people. You can't get away from that fact.
56:49
It's tricky. We've got to be guided by something. But it's, yeah,
56:52
I think we always see the,
56:54
not always, but a lot of the time we see the worst side of people when they're
56:58
fighting on social media They're either very nervous and need confirmation just
57:03
to make themselves feel better.
57:04
So they'll come out with stuff looking for that or they're just angry and for whatever reasons.
57:08
Normally, all anger and sadness normally comes out of fear, doesn't it?
57:13
So, yeah. But, yeah, we've got to respond to it.
57:17
Anyway, this is definitely a conversation where you can continue another point,
57:20
but I really appreciate you coming on, Tristan. Thank you so much.
57:23
If you listen to the podcast, watch out. Look in the notes.
57:26
Great opportunity to see Tristan live and a load of other hosts of great clinicians
57:31
talking as well at the STA regional conferences.
57:34
So yeah, fantastic. Right, that's it. Thanks for joining us live, people.
57:38
Just have a quick check in the comments if anybody has anything to say,
57:42
because I do love people joining us live.
57:44
Nicky Mansfield has said, smashing chat, fellas.
57:47
Enjoyed sharing that hour with you glass of drink and
57:49
a wink wink probably a wink for you tristan you know she's always
57:53
got a crush on you actually steve bar this grand chat
57:55
gentleman thank you very much and then inger 16 13 has come back with 36 i think
58:02
it's good who's the rule reflection pause take a think and then come up with
58:08
your answer or 32 always double yeah well you have to rewind,
58:13
Inger, maybe join us a bit later.
58:14
But the answer is there somewhere. We'll put it in the show notes.
58:18
And Gary says thanks both for an interesting chat this evening. Wicked.
58:21
Thanks, Tristan. Thanks everyone for joining us live. Until next week,
58:24
listeners, take care of yourselves, and probably more importantly,
58:28
take care of each other. We'll see you very soon.