Compassionate Counseling in Audiology

Hi everyone, this is Dr. Michelle Guaveir, speech and language pathologist and co-founder of EasyReportPro.com. I am thrilled to share that I'll be co-hosting a free one-hour presentation with the amazing Mayling Chan on February 3rd at 5 o'clock, Pacific Standard Time. This course is perfect for SLPs who are curious about leveraging AI tools to improve therapy outcomes, while staying within ethical guidelines. We'll explore practical, actionable ways to write better prompts and save time, all while maintaining the integrity, the expertise, and quality of our work. Whether you're new to AI or already experimenting, this session is packed with insights to level up your practice. This course is called AI-powered SLP, mastering ethical prompts for better outcomes, and it's free to enroll until February 3rd with the code AI2025. Learn more and reserve your spot, visit speechtheribypedi.com. Don't miss this chance to expand your skills and make a real impact. Thanks so much for listening and I can't wait to see you at the presentation. You're listening to On The Ear, an audiology podcast sponsored by speechtheribypedi.com. I'm your host, Dr. Dakota Sharp, AUDCCCA, audiologist, clinical professor, and lifelong learner. While I primarily work with pediatric cochlear implants and hearing aids, I am absolutely intrigued by the many areas of audiology and communication in general. This podcast aims to explore the science of hearing, balance, and communication with a variety of experts in hopes of equipping you to better serve your patients, colleagues, and students. So let's go. We are live and on the ear brought to you by speechtheribypedi.com. All the way back in December 2020, I had an amazing conversation with a colleague and a friend, Dr. Logan Faust. We discussed her experiences as a biracial audiologist in her education, training, and early career as an audiologist, and it is still one of the best episodes ever. You got to go back and listen if you have not listened to it yet. But guess what? Today, Dr. Faust returns to explain how her experiences have informed her counseling as a pediatric audiologist, and how all audiologists can use this information to better communicate and connect with patients and families. Dr. Logan Faust is an alumna of James Madison University, both BS and AUD, and guess what? I was right there with her both times, y'all. We went through eight years of school together. It is a wild story. She has been a practicing audiologist, practicing pediatric, specifically audiologist since 2019, and is currently employed at the Children's Hospital of Colorado. She's obtained certifications in subject areas such as diversity and inclusion in the workplace, inclusive leadership, and was selected to participate and complete an intensive diversity equity and inclusion course provided by her current employer. Logan has been an invited speaker at both conferences and graduate courses to discuss DEI initiatives within the field of audiology. Dr. Faust grew up as a biracial individual in a rural community and spent most of her life as one of few often sold persons of color in her professional and personal spaces. These experiences in both personal life and educational pursuits have taught her how to mitigate behaviors, conversations, and incite change regarding aspects of race and marginalization within her community and work. She provides personal experiences coupled with researched ideologies to help provide additional perspectives and discussions about race and its explicit and implicit impact on our interactions as professionals, both amongst each other and with our patients. Logan has a passion for working with and precepting audiology students. Trust me, she is so good with students. She's a great teacher and she creates leads. She creates and leads DEI and inclusion initiatives within every professional sphere she's a part of. Before we get started, just a couple of financial disclosures, I received compensation from speechtherapypd.com as the host of on the ear and Dr. Faust received compensation for her contributions to this presentation. Well, it's been, oh my gosh, Logan, four years since we did this last time. How much life has changed? We got kids now. We are different people. It's truly so bizarre what can happen in four years and how different you can be in four years' time. And I'm so excited to be about back. Thank you for inviting me back, but it feels like a lifetime. I've had a baby in that time and I feel like I've aged approximately 30 years. I'm so glad you're here. I'm glad that this is kind of, it feels like it builds well off of the last time we spoke. I did get a chance to go back and kind of like listen at two times speed. I yesterday just to kind of catch up. I was like, because it's been a while. I mean, it's been so long to jump in and we keep up, but like not as much professional as I wish we could with you being so far away. But with all of, with all that being said, our hope with this conversation is to really build off of what we started talking about with sort of biases impacting our professional lens. And then now I think you had the idea to kind of transfer this to the next step of, okay, how does it actually play out when it comes to counseling? Because that's really where conversations happen in terms of care, right? Yeah, absolutely. And I think a catch phrase that I say so often professionally is you don't know what you don't know. And you know, with our first conversation in this one, my goal is always to provide a perspective that you may not have considered. Or there may be things that you're already doing that are fantastic, but you don't understand the impact that they may actually have on families and patients. And so I hope that through our conversation, we can identify some things that some people may have never thought of before and understand the things that they are doing really, really well, why it matters so much. Awesome. I think that's going to be a great jumping off point for everything. So with those goals in mind, let's jump off with kind of one of the things where I feel like you and I just connect so well on, which is the fun of building rapport with families. Like we love connecting with people, we love finding common ground and being like, oh, what's that on your shirt? I love that thing. I just remember when you and I were students, like that was just one of the things we enjoyed doing. So yeah, that's something that might come naturally to a lot of people, just that idea of like, you know, trying to really quickly build a connection with a patient or a family. But what are people who struggle with that? Like how do we be conscious about what rapport building looks like? Is that's even a question that makes sense? And that is a question that makes sense. And so when you look at research that talks about rapport, there is a really great paper English God Robinson from 2022 that really sought out to do a meta analysis to understand what rapport is and how people do rapport well. And what they found after looking at 500 articles and then limiting it down to like 30, they found that there actually is no common definition of what rapport building is or what it looks like. And so we talk about rapport a lot, but there actually isn't any set definition that every person can certainly relate to. But there are some things, there are some perceptions that we generally accept and we generally think of when we're thinking about rapport. So definitely having a connection with another person, building respect, building acceptance, having empathy. And we'll talk about empathy at the end, because that's the piece that I think a lot of people tend to miss and misunderstand in how to do that in your counseling. But it's just generally a mutual commitment to a relationship and wanting to build that relationship forward. And so people who have a hard time building rapport in my experience, particularly with students, because that's something that all students have to learn and some do better than others, is that they are limiting the part of themselves that make who they are, who they are in their appointments. Because there is a lie at some point we were all told that you can't be empathetic during appointments. I remember in our undergrad, we had a class at some point where they're like, and if you ever cry during an appointment, you are a monster. It's a professional. And I can't say that I have cried during a diagnosis or something like that, but I have cried when a parent told me that their child is now saying 10 words when they weren't saying anything at all, because that's a natural thing to do. And so when you're building rapport, I think it's really important to remember the elements of who you are and bring that to your appointment. You and I are very naturally silly kid people. We are sit on the floor, sing songs, see how fast their write-up shoes go, kind of people. Those are things that come naturally to us. And when I'm talking with students, my goal isn't to make them like me, because you're not me, but to identify the parts of you that you can really highlight that are naturally humanistic that you can bring to your appointment, because that will help you build rapport. Yeah, I love that idea of starting off with your own strengths, because there's going to be aspects of how you initiate appointments that you're going to steal bits of that spiel, you know, bits of the way that they do things, but you're right. And inherently what interests you about how, I don't know, how this child is representing their love for Minecraft or whatever. Some people are going to dive right into that and some people that reference is going to go, you know, right over their head. So I think not feeling like you're stuck doing it the same way as everyone else. Well, and I had a student one time. In my appointments, my personal appointments, I call patients homeboy and homegirl, because that is how I talk. And it's not a weird thing in my appointments, and I had a student one time ask me, "Can I call patients homeboy and homegirl?" And the technical answer is, yes, do you feel comfortable doing that? It takes a level of confidence, a level of swag, you know, and there are certainly things I wouldn't say, "skibbity" in an appointment. That's not where I'm at. Yeah, I literally had to say that today. I wish I was kidding. I could forth with the routine rule. I say it to build rapport with the teenage patients because I think it's so cringy. So I'm like, "We're going to skibbity to the booth." But yeah. Now, what about on the other side of things? So that's kind of giving a framework for what we are coming into the conversation. Do you have any insight into kind of, and I know it's going to vary so much per family or per patient, right? If this is something we generalize to adults or kids, like what they bring into that initial rapport building aspect of the appointment. Yeah. And so what my last talk with you was a lot about was about, you know, race and healthcare, or those kinds of things that we need to take an account for. And I not to put you on the spot, Cody, and I'm not going to share anything I shouldn't share, but you have a really powerful story about how you grew up and where you came from. And there are a lot of things that we relate on in that. And so there is so much history that we can't possibly know about a family. There's so much generational trauma we can't know. There's so much systemic racism that has impacted grandparents that is a top behavior that comes down the pipeline that is showing up in your appointments, that you can't possibly know about your patients. And so there is a lot of consideration you have to make keeping these things in mind, especially when you have a patient that doesn't necessarily look like you, especially if you have a patient who doesn't speak the same language as you, because there are historic things that have happened in our healthcare system that have nothing to do with us that have played a role in families and what they remember of the healthcare system. And an example of this is in my family, growing up, we used to dress really, really nicely for appointments, like church vest for appointments. And that was just the norm. But now that I'm an adult, I recognize that was because my parents wanted to make sure we were taken really seriously during our appointments and that morning judged on socioeconomic status or looking a little slowly. My mom was the kind of mom who would have a toothbrush, a change of shirt, and she would brush our hair in the car before we went to a doctor's appointment. And those are still things that I see in appointments. Now I have colleagues who sometimes comment, "Did you see how well dressed that baby was?" His hair was parted, his hair was gelled, and don't realize, and maybe the family may not even realize. That's due to a generational-talked systemic thing to try to avoid bias. And so, knowing the history of how bias has showed up and knowing how bias may show up for you, really matters when meeting a family for the first time because there are things that we can't control, but there are things that we can build upon in our appointments to gain trust. I think that's great. And I love that you mentioned, sometimes when we go into these initial appointments and there is a language barrier, maybe we're working with an interpreter or situation like that. I'm wondering if you have any insights for those kinds of conversations, ways that we can approach, be approaching them more compassionately or in a way that you feel is more likely to build rapport and trust in a faster way. I would say if you work in a system or in a geographic area, where you tend to see a certain kind of demographic of patient, it's really important for you as a commission to learn about that demographic. When I was in California, easily 30% of my patient population would be non-English speaking during the day, probably more. And so I thought it was really important for me to understand culturally how people receive information like this, because not all cultures, not all demographics, not all nationalities, hear something like hearing loss and accept it, or acceptance looks really different. And so when you're working with another family, especially if you know that, again, if you know that your patient population is going to be different than yours in a broad sense, it's really good to start to research. How does this tend to be received in these demographics of people? And then using an interpreter as a skill, people think it's really, really simple, but you have to really control how you're speaking, how you're delivering information, but also making sure you're actually talking to families. That's one of the number one things I correct in students right away is that they talk to the interpreter and don't talk to the family. And it's the interpreter is there, but they aren't the start of the show. But learning how to say what you need to say without slang or colonialism, which is really hard for me, because I speak almost exclusively in familiar phrases, because they're interpreted in a weird way, or saying things like, "I'm going to take a peak in your ear," is an interpreted the way that you think it will be. And so I think really being able to describe the information that you're trying to give in a way that a young person would understand it, that tends to be the easiest way in interpretation. And then from their questions, you can understand how much more you can beef up the conversation you're having. Yeah, I think that is perfect information. And I completely agree, especially with colloquialisms too, because there's so much value in virtual interpreting. Like, we literally wouldn't be able to see the volume of patients we do without how valuable having an iPad on wheels that can interpret almost any language I can imagine. I can find and someone would be able to support this family. That's amazing. But when you have an in-person interpreter and you're saying something like, "Alright friend, let's take a little peak in those ears." They are right there. They see everything that's happening, whereas the iPad has a pretty limited perspective. And they know exactly what your intent is, and they're going to use a fun voice, and it's a completely different energy. So I just want to shout out our in-person interpreters. I love them. Yes. We have a woman named Alda who is in our clinic all the time, and she just gets it. Like, once they're consistent too, they have such an understanding of the terminology you're using. They're not like, "Yeah." I've heard, you know, in Spanish, four different descriptions of a cochlear implant processor, you know? And everyone's a different vocabulary word. And I don't know how the family's interpreting that word. Yep. I just love our in-person interpreters shout out to them. Shout out to all interpreters. But really, yeah. Thank you, Alda. Another caveat to add to that, though, is I think it's really, really helpful, especially when I was at Stanford. Before I would bring the family back, I would call the interpreter. It's an extra couple of minutes, a couple of dollars. But I would tell them what our appointment was for, and I would go over key terms that I know would be different, the difficult to interpret, that they wouldn't probably just know off the cuff. Like, Microsia, an atrijan describing what they were and saying, "Ponto, there's no interpretation for Ponto. That's just what it's called." And that helps tremendously for me because then the flow of the appointment keeps going. So they're not looking at stuff or asking me to explain something for them. That can slow things way down. I completely agree. And then also getting back to your point about looking at the family. Yeah, that's another thing I'll definitely see students struggle with. And I think there's so much that we can communicate in those moments when we're emphasizing, especially when we're explaining technical things. Like, this is how you unplug and plug this in. When we say that, and then we pause, and we wait, and the interpreter interprets that. And then we may be pointed to something. So it's important that you kind of recreate it as it's interpreted as well. It's important that you kind of recreate it as it's interpreted as well. It's important to teach the students to do it twice, really, every time. And then that also reminded me. So just recently, I was at the North Carolina Academy of Audiology. And there was this great talk by a parent advocate who is on her way to becoming a teacher of the deaf. I don't think she's graduated yet, but her son has charged syndrome. She's an amazing speaker. Her name's Janay Amal Morris. And she gave a talk on, it's really like on its whole family-centered care. But she had this cultural context in this term that I'd actually never heard before called cultural reciprocity, which is basically the circular you know, movement between looking at your own, which I think is an examination of implicit biases, right? But like your own cultural things you bring into the appointment, which I think is both implicit biases and also those strengths that you mentioned at the beginning of our conversation, right? And then you take the time to learn about the family's culture. And then from that, you are more competent in what you understand their culture to be and how that's going to impact the care. And then the next part of the circle was like basically changing how you practice because of this merging, or not even merging, but kind of, you know, this ebb and flow and balancing between cultures. So I really like the term that you just use and the reciprocity part of it, because that's so important. There's another term that is also pretty widely used. And I tend to start all my talks with it. It's something called a positionality statement. And so when you're doing a positionality positionality statement, the goal of it is for you to either say out loud or to write down things about you that have helped form particular views that you already have, or particular beliefs that you already have. And through that, you can start to decide how is that impacting my patient care? So some of these things are how do you identify racial inequality? What's your gender identity? What's your family makeup? And by that, I mean socioeconomic status, size, class, the demographics of your town, which is politically, socioeconomically, racially, if you were in a rural metropolitan area, all those things really matter. And we don't think about that because we think, oh, well, I've grown as a person. I went away to college. I'm now living Colorado and I'm from Virginia, but where you grew up and how you grew up will impact so many of the foundational things you believe in some of those implicit things that you aren't to aware of because it's just how you grew up. There are things that you have always thought were normal that as an adult, you realize weren't so normal or aren't as acceptable as it is. And so same kind of thing and doing that positionality statement helps people again, it can surprise people because these are things that you know about yourself but may not have ever had said out loud or written down. And it can be surprising to recognize, you know, one of the questions I ask, what are the demographics of the closest people you talk to every while? Yeah. Because we tend to surround people, ourselves with people who look and talk like us or have similar beliefs. And if your scope is small, it's hard to understand the perspective of someone else. Yeah, that's awesome. So that's homework for listeners. Write down your positionality statement. Now I love that. I've never thought to do something like that before. I think that's my fantastic idea. And I can see how that would lead to a lot of growth. Okay, so we've written our positionality statement. Yeah. We're making, we're making lots of progress there. And we're ready. We've prepped about this, you know, we've read up on this patient's case history. We're familiar that their culture might be something different from ours. And we've done a little back, a little bit of reading to understand, you know, how can we deliver news well? We've got our interpreter ready. But then it just, we're just not clicking. We're not reporting. You know, like, what happens in those moments for you? Or how do you help students through those kinds of moments? So again, I speak almost exclusively in colloquialism. So something else that I say that is a Southern colloquialism is that you can be the sweetest peach in the orchard. And some people don't like peaches. And that's just a reality of life. There have been many a patient who I just don't click with until the end of the appointment when I'm going over counseling. Because it seems, report building will help you move into counseling. Report building will help you deliver news that people aren't expecting. If that natural interaction is not there for whatever reason, if you become a compassionate counselor, that will naturally help you build your report. Because if people can understand what you're saying. And if you're projecting these are the sense that you actually care about them. And you're trying to help them make informed decisions about, in my case, their child's life, the report comes because they see that I'm working really, really hard to give them the information they need and the tools that they need for their child to be successful in whatever that realm looks like. And that will help me build my report for future appointments. No, that's, that's awesome. I've, I've, I've literally felt that today. We had a family where we started off. And it was just kind of like shaky, like things weren't really firing. The student was kind of trying to lead and she keeps looking and I'm like, yeah, we're, keep, keep, keep going. And then we get the, we get the patient family and the booth and we close the door and she's like, is the vibe kind of off a little bit? Yeah, it's a little off. And then when we come out of the booth and we're kind of getting into things and it becomes much more a conversation about care, the energy completely shifts. Like it becomes where everybody's more invested in that conversation. So I think you're totally right. Sometimes you, sometimes the, sometimes talking about their minecrafture doesn't help. Like they're just not happy to see you. Yeah, you gotta just push through and get to the point where it's actually open anonymous conversation. And I, I think that's fair. And there, there's another study terrain at all in 2021. They did some surveys with patients to see who and what characteristics had good rapport? Who was building the best rapport? And they identified the metric that if this metric was the highest, everything else improved. And it was empathy. If your provider had empathy during your appointment, during your counseling session, their trust improved, something called stereotype that if we have time, we'll talk about it. But if we don't, that's okay. That improved their, their perception of discrimination improved and their adherence to follow-up and treatment plans improved. And so counseling is such an important part of the story. So even if you're not a natural rapport builder, if you can build your counseling skills, which is 100% improvable for everybody, your rapport will naturally improve. Wow, that is, that is a tagline for this episode. I love that. I love that because we're kind of transit, I love this transition actually kind of from, okay, we've gotten through the rapport aspect of it. We've gotten through the appointment. Now we need to really talk, you know, seriously. It's a little bit less, get to know you a little bit more. Here's what we need to make sure you understand. Before we get to that really quick, because I have a feeling we're going to, we're going to circle back to biases in this conversation. I know that the concept of implicit and explicit biases are like very much part of the zeitgeist now. They're part of a lot of training people go through. But just in case, could you just give us a quick recap on those? Because I know, if there's any other kind of vocab words, you think you're going to come up here that you want to go down a little bit for us. So implicit bias is, well, let's start with explicit, explicit is very easy. Explicit bias are biases, prejudices, feelings, thoughts that people know that they have and they express openly. And so for me, an explicit bias I have is that I hate the color of burnt orange. Don't like it. I'll tell anybody that you can look the best in burnt orange. And I will tell you, look fantastic, but I would never, ever do it myself. Hate burnt orange. That's something that I know explicitly. And I will say it loud and proud. Implicit biases are sneakier because an implicit bias is a thought for feeling that you don't necessarily know that you have. So in audiology, what an implicit bias can be when you're doing ABRs for people who do ABRs on infants, you scrub their skin, it turns red, you put an adhesive on it, the adhesive usually leaves a residue. There is an unfortunate trend in audiology where if you have patients of lighter skin, you tend to warn them, you're going to see redness and you're going to see that white residue left over. For patients who have darker skin, people don't think it shows up. And so they don't say that. And so that's an implicit bias. You are seeing someone with darker skin and feeling like the same counseling tip or the same rules don't apply. And that's where I get sneaky because you, as a person, are probably like, of course, I treat all my patients the same. But there's sometimes something that's underneath the surface that you don't even know because you don't know what you don't know. That's changing how you're interacting with patients and families. And that's really, really hard to identify unless you're actively looking for it. Yeah, that's great. That's great. Were there any other terms that you feel like we want to break down before we kind of get into some of these things? I feel like maybe they'll just come up. The last one, which is always a little bit of a knee jerk one, but I like to talk about it. And I always talk about it is privilege privilege is something that we all experience. And before I don't jump into it, I like to start with that privilege isn't a bad thing. Sometimes we have these conversations and people leave thinking having privilege is a terrible, awful thing. But it's nothing that you can control. You know, I grew up very low SCS. I grew up with a lot without a lot of resources. I hope my daughter Violet has all the privilege in the world. I would want to give her that privilege because privilege is helpful. The tricky thing about privilege is recognizing that they're, they're usually things that you can't control about your life or about your circumstance and their things that have benefited you. And so we all experience different levels of privilege throughout our lifetimes. Yeah. But where we get in trouble is when we refuse to recognize it as privilege. Sure. And so when you refuse to recognize it as privilege, you start to think that the field is even for everybody when it simply is not. And so privilege is not a bad thing. I love that people have experienced privilege. Your life has not been made difficult by things. You cannot control and all aspects of it. That doesn't mean that you haven't worked hard for everything that you have. But it does mean that your starting your starting line may have been different than mine. And that's going to look very different throughout our lives. Yeah. Thank you so much for for bringing that back up to you. I think that's awesome. Okay. So we've gotten through our terminology. Everybody's up to date, which hopefully they already knew all of this, but you bring it to life in such a different way, like such a relatable way, truly. I love that you included that specific example to you for implicit bias. Okay. But then if we're starting hopefully over the last few years, we've been making some work and acknowledging our implicit bias. Yeah. And recognizing and acknowledging privilege. How is that shaping how we counsel? Where does that come into the counseling process writ large? Yeah. And so where bias tends to show up in counseling in general, there are a couple like main points. One is the time we spend with patients to go over actual counseling. This tends to be actually more of a thing. I don't even think that it's bias-based because I find that a lot of clinicians will push, push, push, push, push to get all the information they possibly can in one appointment and then have such a little time leftover to go over what all that means and what the next steps are. But particularly with patients of people of color, the time that providers tend to spend with patients tends to be less. The other thing is when you're actually talking to patients, patients who are providers who have more implicit bias than others, tend to do some not so nice things that include dominating the conversation. So I'm giving you all this information. I'm telling you it's important. I'm not giving you any opportunity to ask me questions. I'm not giving you any opportunity to clarify. I'm not giving you any opportunity to process. And then the other thing that we tend to do with patients is we infantilize them sometimes, particularly patients with color. And so what that can look like in our appointments is you have a hearing aid patient coming back who hasn't been wearing their hearing aids and saying something like am I have we been wearing our hearing aids? That's a funny thing that as someone who would receive that would feel weird. How I've experienced this in my life, my daughter was having difficulty gaining weight when she was first born, which everybody monitors. And I remember the pediatrician in California said am I going to be happy with you or am I going to be sad? And it was just one of those things where I'm like, I feel like you would not have said that to me if I looked differently than how I look. And we immediately changed providers because it was just enough of an egg that I was like, I don't need that. And so those things definitely come up. And those are the things to be mindful of. If you are pushing a patient and you're trying to get the last two bone lines, you know they're coming back anyway. Do that at your next appointment. So you have time to talk because the talking part is the most important part of it. And I forgot the beginning of your question. So what was your question again? No, actually, no, because I think this, I'm going to circle back to what my question was, because I think you've actually led me to a different question that I'd rather tackle first. Yeah. Could you just give like, what is your counseling definition? You know, like in a nutshell, if somebody's like, because I love how you're talking about how important it is that we get to the talking, right? Like I know, I know what you mean. I know what you mean by that. But it's going to be listening might not because you're right. So much of what we do is some technical and there's testing. But yeah, a big part of what we do and should be doing is the explanation is the planning is the big picture holistic aspect of care. And you're right. It gets shoved to the side so often because of all the technical stuff we have to get to and have we want to explain the technical things. So if we could actually rewind and then I'll circle back to that question again, just counseling in general. Like how do you approach this as a as a topic? So especially when I'm with students, my goal for them is to stand for myself. If I'm meeting a patient for the first time and I have a new diagnosis, a new ID that we have to talk about no matter what we need to do, my goal is to save at least 15 minutes at the end. So I can go over what the diagnosis is, give time for processing any questions and then start to talk about what we're going to do moving forward. In my appointments, I'm a big feeling scale. We talk about our feelings a lot, especially with the children that I serve, but that also is true for parents because one of the things that I find myself saying a lot to when I'm giving news is I know that this was a surprise because it usually is or they may have had an inkling but they didn't actually know what it was. And so giving people the opportunity to take a breath is so so important. And another thing that I think that audiologists tend to be really guilty of is not explaining things in a way that's digestible or easily understood. We all know what conductive hearing loss is. Working with pediatrics, I'm seeing conductive hearing losses all day between November to January. That's just a normal thing. We don't explain what that means very well, especially in the context of like an ear infection or middle ear fluid. And so when I'm with students, one of the things that I challenge them with because you know, you bring them aside, you're going to talk about how you're going to count to moving forward is I have them say what they want to say and often I say, now how can you say that in a compassionate way that they're going to understand? Because we tend to say, oh well, I did phenometry and their eardrums weren't moving well today, which led to a conductive hearing loss. So they're hearing in a mild range that doesn't mean anything. And technically everything you just said is correct. It's correct. Like that's what is this that student wasn't wrong. Exactly. Exactly. But I'm with you. That's not going to be received or understood by. No. And so you know what's an easy thing to say? As adults, we all have experienced middle ear dysfunction. You know, when you have a head cold and your ears are clogged and things feel tight and things don't quite sound right, you're probably experiencing fluid behind your ear. Now imagine experiencing that fluid for four months and imagine experiencing that fluid while you're trying to learn to talk. Those are really difficult things. Those are things that parents can say, yes, I've had I've been on a plane and my ear didn't pop for four days. And can you imagine they know what that feels like? Not being able to pop your ear is the most frustrating feeling. And as an adult, when you know where everybody's freaking out, and it's like imagine your toddler has been walking around like that for four months. Like those are digestible things. We don't put things in context of real life enough. We put them in context of how we learn them in school, which is technically correct, but is not helping anybody understand. Yeah. Yeah. That's a great example of, you know, where counseling needs to change. I'm wondering, so circling back to, I don't know, whatever that question was, it basically was coming from a place if we had you had just defined biases, right? And so I don't know if you have maybe an example, we're probably the best way to come to a process, but like where do we take our new understanding of our, you know, our own implicit biases in privilege and bring that into counseling conversations? Gotcha. So I can see where I lost my way. And so no, no, no, I think you opened up an important, sure, that was a good precursor to this question. Yeah. I think that made a lot of sense. Making sure you have enough time is probably the first thing, because if you're trying to squeeze in what really is going to be a 25 minute conversation into five minutes, you've already done everybody a disservice, including yourself. And so making sure you have enough time, because that tends to be the number one thing that is impacted when we're, when we're dealing with bias. The other thing is not leaving a whole lot of crumbs on the table. Explain what you've got. I think sometimes providers feel like they have to keep information to themselves because they're concerned about things, but they don't have enough information. In my experience, at least in how I counsel, telling parents, this is what I'm concerned about, but I don't have nearly enough information to understand it fully myself is helpful because then they're prepared for the next appointment. And so it's not another surprise, or it's not, especially when there's children who are like borderline, cochlear implant candidates. If you are seeing that they're getting 49% on their word wreck, and it was the first time that they have done that, it's, I think it's so important to say, I'm really concerned about their word understanding. We certainly have to repeat this test to see where we're actually at today may have been a wonky day, but it might be time to start talking about that safety net that we talked about so long ago, that kind of thing. And so I think just recognizing that you need time and that you actually need to provide parents with information that they can understand because in bias, a lot of people also, especially when we're talking to families of different languages, people assume that they're not going to, they won't understand you. That information that you're giving them is going to be over their heads, and that's a health literacy thing. Oh, they're not going to understand it, so I'm not going to go into it. That's actually not true. It really has more to do with how you're explaining it than what the information actually is. Are you, again, making it digestible and easily understood, or are you using a bunch of technical terminology that you had to know to pass the practices? That's not helpful. Yeah, I'm with you, I'm with you completely there, and I, I'm with you in terms of that amount of time allowed for counseling, and you brought up so many good points there. So that's one, that's one important thing. And I'm, I'm with you as well on being honest with parents about our concerns. I feel like when I was a student, I was, I would see a child and say, I mean, I see children with autism all the time. Like, there's so much crossover in my world, right? Yeah. I'm not a professional who can diagnose a child with autism, but I see it all the time and I, I know, we've got to get a lot of that when I see it, right? Yeah. Yeah. And, but when I was a student, and even an early professional, I did not feel like I was allowed to say, these behaviors are concerning. This is not a typical behavior for a four-year-old, you know? And parents, many of the parents who I see who are in that situation, maybe have never seen it, and maybe they don't have any other children, and they don't have a lot of examples. So they don't, they truly just don't know, and no one has told them, or I have families who have concerns, and I've had concerns, and they've brought it up to other professionals and have been kind of like, you know, oh, well, you know, you know, it's kind of it's brushed off. And so those, once you feel empowered to not, you're not diagnosing anyone, and you definitely need to like, approach these conversations with experience, and maybe with, you know, consulting with other professionals as a part of that conversation. Yeah. Yeah. But when you do, when you are able to be honest with families about concerns like that, A, the rapport skyrockets, because they're like, you are being honest with me, and I think it comes back to what you're saying about empathy too, right? You care about me enough to be honest, you're not trying to be demeaning, you're not trying to, you're not trying to be awkward and like end the conversation in a hurry, so you don't have to talk about this one thing that you're clearly concerned about, and that I'm also concerned about, but nobody will talk about, you know, I've had conversations with families that are like this, you know? What you're talking about, this is another vocab word, there's something called validation theory, and this is when you are, it's a lot when you're actually getting like case history and stuff like that, but it certainly is a big part of counseling. So validation in general is just affirming someone's experiences, affirming their humanity, affirming their, the things that they have observed themselves, but in counseling, there's two types of validation that many people do and don't realize what the difference actually is. There's something called interpersonal validation, and that's the empathy and sympathy of being a fellow person, a fellow human being in the space, and then there's something called professional validation. And so what this looks like, interpersonal validation, if I'm seeing one of those classic two-year-olds coming in, not talking, has had 30 year infections in the last six months kind of thing, an interpersonal validation that I could give that family right then, that's going to help me build my reporter, is I am so sorry Jimmy is experiencing that, and mom, I am so sorry for experiencing that, because I know it's hard for both of you, because as a parent, ear infections are the worst. I'm literally, my daughter has one, right now. We gave her a temp this morning, flat as to me, she says, "Daddy, my ear hurt." I mean, it sucks, it sucks, because they're going to be awake all night, they're moodier, they're fussy, they can't hear right, their balance is off, like all those things matter. So saying in that moment, interpersonally, I am so sorry that you both have been going through this, because they both have been going through, that's for them, whatever time. Professional validation, what that will look like in my counseling is, let's say I got a flat temp, I got a conductive hearing loss, I can then professionally say, this all makes sense, you know, you felt like Jimmy isn't hearing you well, he's not responding to his name, you're right, because he can hear me talking, but he may not be able to understand what I'm saying, the clarity isn't there, the quality isn't there, and so both of those things are really important, and we tend to do the professional validation really well, giving them, oh, you have this symptom, that's why you have this symptom, we don't tend to do that in a personal part really, really well. Oh, I forgot what I was going to say, I was going to say something else, but it's not. Well, actually, you let me say, you just keep it on, you keep it on, you keep it on the rails, it's crazy, because normally when we're chatting, it's like, I feel like we can easily get off the rails, but you keep it on the rails, because you brought another point, which was when we're in these moments of counseling, and how, you know, what we say can depend, sorry, how we counsel can depend so much on the health literacy, like that impacts things, and we tend to underestimate the health literacy of families who are not English speaking, right? What are your tips for, you know, assessing health literacy in the moment? Now, I've worked in some hospital systems that literally complete assessments to understand, like, the reading level of families, and I struggled with that to feel like it made too much sense, and even then, I feel like that will impact, you know, what you're written, you know, reports might look like, but in the moment, okay, now I'm going to talk to you because you have a fifth grade reading level, like, I don't know what that means, you know, so what does it look like for you to in the moment assess health literacy, and then impact your counseling based on that? Yeah, no, and that's a really tricky thing. I've been in hospital systems too, that also try to assess those things, and the issue is that a lot of those assessments aren't honest. Another vocab word is something called stereotype threat. Stereotype threat is when a community of people doesn't matter who they are or what their marginalization maybe, are concerned that they're going to make their community look worse in some aspect, and so they don't necessarily answer things, honestly, and so, for example, if I was being surveyed, and the survey was about being a black person versus being a white person, and I know I'm being directly compared to a white population, my answers are more likely to be skewed in what I perceive to be positive, so I'm not adding to the stereotype of my community, whatever that may look like, and so when doing health literacy checks and those kinds of things, it's really hard to know if the evaluations are honest, because people inherently are scared that it's going to, if they are honest, it's going to negatively impact them, and so in the moment when I am counseling, and I'm doing kind of health literacy checks, people think health literacy is just under, it's just like kind of reading is just understanding written information, it's not, it's understanding the entirety of your appointment, and there's a great statistic that said, I think it's like between 40 and 80% of what you said during an appointment is going to be forgotten, depending on what you're talking about, and of that, what is it, 60 to 20% that's remembered, only 20% of that is going to be accurately remembered, and so when I am giving news, the first appointment, I really don't expect them to remember much, because a lot of the times, it's a big surprise, we weren't expecting this news, or we weren't expecting it in this way, or we were expecting it, and now things were confirmed, and it's that initial feeling that many parents go through where they don't know what their child's life is going to look like anymore, and so I'm still going over information, but I am anticipating that once we were able to digest it over whatever period of time we had, we're going to go over it again, because it's just not going to be retained in the same way. I think this is most important for patients who do speak another language, because in my experience, this is purely anecdotal, I've never read anything actually about it, when I have patients who, it's pretty clear that, you know, there is a power dynamic that exists, because I am their clinician, they are patients, they're coming in, but when I have patients who, particularly, I know, are low SCS, who speak another language, who may have questionable immigration status, kind of things here, they tend to be yes men, so you're giving them information, they're just like, yep, yep, got it, yep, yep, yep, yep, and they're just moving through the conversation, that's when it becomes so important to pause and say, I've been talking a lot, what are your feelings, what are your feelings, and waiting for them to say something, and saying, I don't have thoughts, and if they don't have that saying, do you have any concerns about school impact, do you have any concerns about what this may look like at home, like trying to give them opportunities to actually share their feelings, and they may not, and that's okay, and that tells me that I still have work to do with my rapport, so they know that they can trust me to have these conversations, but I think it's be wary of the yes men, because the yes men are just trying to get through your conversation, to get out of there, and a lot of times, or the alternative of that is that they're trying to prove to you that they understand even if that happens, and so that's really, really tricky, and so if I have a yes man, I'm stopping more often, and I'm trying to phrase things again in the way that's more digestible, so everybody can relate to it, because there are ways to describe a hearing loss where all of us can relate to it, and you just have to have the practice to do it. Yeah, it's not, I don't mean to portray it in a negative way, but it's sort of like calling their bluff, like I'm not going to let you get away with just guessing your way through this conversation, because it's important, and I know you care, and me stopping you, and making you participate is me showing you, I care a lot too, and I want to make sure you're part of it, right? And there's another thing that I've been asked quite a bit, and it's tricky because with some patients I do this, and most patients I don't, is having them repeat some of the information back to you. The reason why that gets really tricky is because that comes off extremely condescending, and it comes off condescending, especially if there's a there's a natural power dynamic, especially if you have differences in culture and language and those kinds of things, because instead of it trying to be like, I gave you this information, I just want to make sure on the same page, what it comes off as, as a marginalized person is, oh, you think I'm dumb, like you think I don't understand that, and so I would just say those of you who have patients repeat things back, maybe you have a technique that I don't know, and I would love to know it, but being mindful of those things, because that's where again, these biases in these generational structures that have nothing to do with us come in, because if you can have a great, great thing going, and then you have that question and it makes you feel like, oh, they actually don't think I understand what they're saying. I've been, I've been in that moment and trying to use a teach back where I felt like it was going to be effective. I do have one version of it that I feel like works a lot of the time, which is who else takes care of kiddo, and how, okay, what are you going to tell them? Like, how would you tell them how to do this? That way, it's not you teaching me, and I already know everything. It's like, you just tell me like, what's that going to look like? How's it going to look when you tell them? What do you think? That's great coding. I'm going to take that forever. It just came up as you were talking about daycare. Like, okay, so how do we explain this to daycare? What do you think? And then it, it really, they don't, I don't think they see it as a teach back moment, right? They're really just thinking through what that's going to be, but I see the holes that I need to fit in with what's right. No, that is perfect. I'm certainly going to use that moving forward, because I was struggling with figuring out a way to do that, but that makes a lot, a lot, a lot of sense to me. Oh, and I guess that kind of brings me to another part of counseling in general. If you had a patient, that's like, with you for a long time, and they're coming back and they're doing things like, they're not wearing their hearing aids or their data log games really low and stuff like that. I think a part where we can be better as counselors and their bias tends to come in is that we're assuming parents aren't trying their best sometimes, and they're like, oh, they're just letting their kids do whatever and not asking the necessary questions. Like what, like what you just said, which is something that I do ask, who, who else is involved in their care is, is little Tommy with you all day, or does he go to daycare or is grandma with them? Because I've had patients who, one that comes in mind specifically four years old, grandma takes care of him all day. Data logging was really poor. Data logging was like maybe three hours a day or something like that, which I still celebrate by the way you are putting in an effort. And I want to make sure that you know that I see you putting in an effort comes to like, I didn't know grandma was taking care of him and grandma has really poor dexterity. And when he would inevitably take out his hearing aids, she couldn't put them back in. And so what that became was a conversation and a teaching moment for me where I learned how to put hearing aids in with my knuckles. So mom could teach how grandma to put them in with her knuckles. But we again, the biased portion of that is that we assume the worst sometimes of our families and don't do enough investigative journalism to find out what the circumstance truly is. What the fear is. I'm afraid this in Jimmy to his daycare with his hearing aids because I'm afraid they're going to get lost. Those are things that are important to know that we're not asking. Yeah, I've had big emotional conversations. I can and one mom comes to mind where where time had just been a consistent issue, a consistent issue. We talked about every strategy in the book. And mom had never mentioned that she was really at home with like a babysitter who was a family friend and mom. And this was also through an interpreter. So it's also hard to have those kind of like big, deep, heavy conversations. But fortunately, it took multiple visits from because I would ask, basically, like, are you home with her? And she was like, yeah. And we were like, okay, so what does that look like? What are the routines? We tried all the things we do. And then finally, it was like, actually, I'm not at home with her. It's a family friend. And I can't challenge this family. Like, I can't say this because I need the care. I need the care, right? I can't do this. So it really was an ah, well, then, okay, I'm sorry if I've been making you feel guilty all of this time. Like, hey, I don't want to, but be it wasn't even your fault. So let's reframe how we can talk about this entire thing, right? One one thing in pediatrics, particularly that gets under my skin and just doesn't sit well with me at all is the phrase, I would do anything for my kids. And I've heard it during implant meetings. And I've heard it during like stuff like this where they're not wearing their hearing aids appropriately or the kids are only wearing them at school, whatever the circumstances. And I think, again, where the bias comes in is sometimes doing everything for your kids is having a family friend who you can afford to watch your kids. So you can go to work. And if that person isn't willing to put their hearing aids in, the fear of losing that affordable care is so real. Or sometimes the, you know, doing anything for your kids is I keep scheduling appointments and I have to keep canceling them because I work an hourly job and I can't talk work. And going to work is honestly so much more important sometimes than our appointments. Because if they don't go to work, nothing else is going to be possible for their family. And so that, that sentence, I would do anything for my kids. A lot of these families are in fact doing everything for their kids, but they're everything looks different than what our everything looks like. It's such a good reminder. Yeah, that's such a good reminder. It's been a weird week. I feel like everything we've talked about, I've had a patient this week. But just today, I had a family who was severely affected by Hurricane Helene. They live about three and a half hours. I think it's more like four from our clinic. And their son was activated in August with his implants. And it's been so hard for them to get here. He's a very, he's got a lot of, he's got a lot of needs. And mom was so nervous to tell me today because we've had appointments. They've had to cancel. We've been, we've been trying to like, okay, how can we get this appointment? You know, we're trying to be very creative with scheduling things. And she didn't even want to say like, well, dad lost his last job because of other medical needs and appointments that he had. He has a new job. And I know we've been trying to get in to see you. And I know we have an appointment in December. But if we need to see you in January, he's going to get fired. And I don't want you to like, she didn't say I don't want you to be mad. But like, you know, something along those lines, I don't want to get in trouble and not bring him. Oh, no, she said, I don't want you to think I don't care about my kid because I can't come to an appointment in January. And I'm like, Dad's got to have a job. That, like, you need to know, that's, that's so important. She was like, Oh, thank goodness. Like, I mean, just being able to, coming back to that validation, right? Like, you are, you are totally right to be caring about those things that it doesn't really care about your kid, right? And then the next step from that, because that's really a testament to your rapport building and you're counseling with the family that they would share that with you because getting to that point is difficult. And it's, I think, that's, that's something that I, when I learned that I'm good at rapport building and counseling, it was honestly pretty recently. I thought I was, you know, that everybody was doing the same thing. But I had, we have audiology assistants at Children's Colorado, which I'd never had before. And the audiology assistants comment on it a lot, which surprised me in what made me start thinking about it. But when patients start sharing those things with you, they are trusting you. And the next step for us is trying to create resources and follow up plans that make sense. If I have a family that's an hourly family and they have a little itty bitty baby, I'm going to teach them how to cut tubing and to retube their, their child's ear mold, like, pretty immediately. Because then that's not an extra appointment that we need. Do we need to make ear molds? Yes, that's inevitable. Do you need to come back for me to fit it? Absolutely not. That's something that I can take off your plate. Or I had a family share with me that they were temporarily in a shelter and she was really embarrassed about it. And then it was, it was an opportunity to talk about resources that the hospital can provide and what's available locally because those things matter. And it's like, yeah, we had things that we needed to do. Did I do aided testing that day? No, because aided testing wasn't the most important thing for us to discuss that day. I'm still a person and they are still people and addressing personal needs sometimes is what should be the foremost of your appointment. Absolutely. It's such a good reminder. At the beginning, you kind of talked about how empathy kind of drives compassionate counseling. And I love that specific stat you had. I mean, you had the data for it. Being an empathetic counselor is the most effective, you know, tool to bring into even improving rapport, right? And let alone like being able to convey heavy information effectively. So do you have any tips for it? It's kind of weird to say like, how do you help us improve our empathy Logan? But like in that realm, I mean, these are skills people can work on. So I know we're kind of coming up close to the end of our time here. But how? What's your, what's your mission statement when it comes to improving empathy and letting that drive your counseling? So I think we first need to understand the difference between sympathy, empathy and compassion. So sympathy is like the cognitive ability to understand that someone's going through a hard time. Oh, you know, oh, Cody, you, you spill coffee all over your favorite shirt. Oh, that stinks my friend. I'm so sorry for you. That is kind of where it ends. Empathy is sharing in someone's emotional experience often through personal experience. But what's often overlooked by empathy is that you don't have to have that shared experience to provide empathy. Empathy again is sitting in the moment with a family when they need it. And so I don't have a child with hearing loss. I don't know what that's like to receive that news. I don't know what it's like to try to keep hearing aids on a toddler. Those are things that I imagine are really, really hard. But I can empathize with the family in recognizing that they're trying their best. And that it's a hard thing and that I'm not going to fuss at them because their data logging is low for this month because their toddler has been drawing off their hearing aids. And where compassion comes into this is that it's it's a little bit of both empathy and sympathy put together. So where we get off the rails with empathy is when people start to say things like I know exactly what you're going through. Whether that's true or not, because now you're making the appointment about you. You can be an audiologist with hearing loss and saying, I know exactly how you feel. That is not always appropriate. It can be. But most of the time it's not or to say that you know how someone's feeling when in fact, you don't. It's really upsetting for a lot of people. So compassion puts those two things together. You can be present in the emotion of the room when it's happening. And you can have the cognitive dissonance to still walk them through the path that you need to walk through. Whether that is explaining beginning to end what you're going to do or explaining in that moment. This is what we're going to talk about today. At the next time we're together, we're going to talk about some other stuff because not everything needs to be done in that appointment. So when you're trying to do more empathy in your appointments, what you're really trying to do is increase your compassion. And the compassionate side of things again is bringing the humanity side of things into play and starting to reduce that power dynamic between you and a family. Because again, naturally, there's an inherent power dynamic that exists. However, if you create a power dynamic in a way where you're unapproachable, you will never receive honesty. And you'll never get to that point with a family where they can tell you what they're actually concerned about and what their actual struggles are. And so to improve your empathy and compassion, you again have to check in with families and give breaks. And you have to honestly talk about your feelings because people can go across the board and do everything perfect, perfect, but are struggling. And if you never get to that point where you can identify where they're struggling either emotionally or pragmatically with something, then your rapport will never improve. Yeah. And so give people the space to feel their feelings. Don't try to rush them through it. Recognize what can be saved for the next appointment because not everything has to be done. You know, if you didn't ABR and they have hearing loss and they live locally and there doesn't seem to be a lot of barriers to care, you don't have to do a consult that day. You don't have to do an ear mold that day. Let them digest that information and have them come back if they're willing to do that. The opposite can also be true. I had families who would drive four or five hours to come see me when I was working at Stanford. And so I would really make it a priority to see if they were ready to get as much done that day so they didn't have to take another whole day off of work to come see me and spend the day away from home. And so recognizing what your patients actually need in that moment, which takes practice, but it's so important in building the core and then counseling effectively. Yeah. Hmm. Logan, that is good stuff. That is really good stuff. Taking the time with families. It reminds me of a talk I just saw from Dr. Caitlin Sapp. She's like one of the one of the goats of pediatric audiology. I hope she hears this. But she was just giving a talk on building urgency with families, which I do think in pediatricists is so critical. And is a big part of one of our goals when we're counseling right is like making sure you understand how important this is because it is really important. And in these family interviews, they did that said like, how did you know that this was important? Like what did the audiologist do that made you feel like, oh, I need to be taking this seriously. And there were some things that we do that were like things that we say, like hearing loss is going to impact their language, things like that, right? Yeah. But what was also really important were the non-audiology things that were done, like the audiologist, like it was clear to me they were working through their lunch hour to explain these things to me. And that made me feel like this was really important. Or they gave me their, you know, they they introduced themselves by their first name, which something we might do just to help build rapport, right? But that made it clear to me that this was going to be a lifelong relationship that I was going to have them because this was an important thing, right? So that comes to mind too when it comes to like, I don't know, just how we how we input urgency into things is also those the same way that we're can we're compassionate or we're empathetic and we there isn't a layer of compassion there. But I like how you made this to I wanted to make sure that I did I can understand that you made I think that was fair. But yeah, it has an impact on how families perceive the importance of what we're explaining to them, right? When we when we do it in this way, when we take that time, when we are serious about carving out that time for these conversations, it's not just important that they hear the information, it's important that they see how important it is to us. Yeah, yeah. And you know, it's something that I always say to families too while I'm counseling. This is completely off topic. We were talking about it a little bit before research reporting is I tell families new ID families that it's so important for you to like and for you to trust your audiologist. And if at any point you feel like we are not a good personality fit, let me know because it doesn't hurt my feelings. It's more important for me to for me to get you connected with someone who you like and who you look forward to seeing. And if that's not me, that's okay. And I think that helps. I think I think it helps give them the opportunity to seek a second opinion if they want to seek a second opinion. But also, you know, I come on a little strong with some people. Not everybody likes to aggressively sing some of us. And that's okay. And that's more than opening up with me. And so I think letting families know that because again, setting them up that this is going to be a lifelong relationship, I'm going to have the privilege to seeing, you know, your daughter in elementary school and then start to go to her middle school dances and then, you know, do do performing arts and high school kind of stuff. I look forward to that. That's why I wanted to be a pediatric audiologist. But you have to trust me and you have to kind of like me at least a little bit. And if I'm not the one, let me find the one for you. Yeah, I was going to ask you about if we wanted to talk about getting into like getting fired. Yeah, because everybody just say, I'll know listeners, we're like literally right at our time. I know we don't have too much time. But you did give, I was going to say, what do you say? And like, I think you already said it, right? You gave that preface and that gives families the opportunities to do that. But just know if you're listening to this, it happens to everybody. You could literally be the greatest pediatric audiologist in the world. And you were going to get fired by a family at least one time. It's going to happen. And honestly, welcome it. If you're fired by a family, it clearly wasn't a good fit for whatever reason. And I hope they find the right fit. Yes. That's everybody wants because it makes everything more enjoyable for everybody. Yeah. You mentioned this is also kind of like on that random thought thing. But with you mentioning that the growing up with them aspect of things, I feel like we're just now at a point in our careers where like that's starting to sink in for me a little bit. You know, when your first getting started, it's like, everybody's new. And it's like, oh, I just saw you. Like, I just, I see everybody so regularly. But now I've been here long enough where it's like, oh, my gosh, you're like big. And oh, my gosh, look at your pictures from your school dance. And look at your football. You know what I mean? And it's, whoo, it's getting, it's getting real heavy. It's getting real heavy lately. No, for real. I had a family who contacted me via LinkedIn, because I've left Stanford and they didn't know how to get into contact with me. So they found my LinkedIn. And they sent me a picture of their daughter who is now 13. I first met her when she was eight, I believe. And she and her mom showed me a picture because she was doing musical theater. And she was sitting like this with her hearing aids on. And she just wanted to send me an update because we had talked about it a lot. And that was something that was a goal she had. And it just warmed my heart so much because those are really the things that I look forward to the most as a pediatric audiologist. I want, I want to hear those stories. And I was, I was so touched that they felt like I needed to be involved. And I was happy that they did. It was very sweet. Oh, that's lovely. Well, speaking of lovely, this conversation was lovely. It has literally flown by. I had more questions for you. We ran out of time. We literally ran out of time. But this, it's always a pleasure to have you log in. And I appreciate all of the hard work you're doing and the talks you're giving and this kind of information is just so critical and changing how we talk to families and it's 100% for the better. So thank you for joining me. If people had more questions for you or they want to invite you to their conference to talk because I have a feeling they're going to have lots of people who don't want that. Because this is, this is, this is important stuff. I really think this is like that kind of so tangible, so clinical, you know, the things that people really need to hear in these kinds of spaces. So how could they get in touch with you? Honestly, I hate to be that person that linked in families and professionals alike. I think that that will probably be the best way to get in contact with me. But you know, our field is so small. Everybody knows someone who knows someone. And so I don't think it'd be too hard otherwise, but probably didn't. Awesome. Well, I appreciate you taking the time. It's been so lovely to have you. Thank you, Cody. All right. And that's all for today. Thank you so much for listening, subscribing, and rating. This podcast is part of an audio course offered for continuing education through Speech Therapy PD. Check out the website if you'd like to learn more about the CEU opportunities available for this episode, as well as archived episodes. Just head to speechtherapypd.com/ear. That's speechtherapypd.com/ear. Enjoy listening to On the EAR, but wish you could earn Ash's CEUs for it. Start today. 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