Dr Louise Newson: [00:00:02] So today on my podcast, I've got Dr Kumi, who is a real inspirational doctor. She's very educated. She's very... She thinks a lot about her patients. And what we want to talk about today is about how women and patients can advocate for themselves, because there's a lot of noise out there. And I think it's getting more confusing for people. A decade or so ago, when I started to do more and more menopause work, people didn't really seem to know much at all and I was giving some very basic information. Now I feel people know, but other people with their own agendas, their own conflicts, their own ideas, often sponsored by various people, are coming making noises. And I feel it's a really confusing space for people. What do you think?  [00:00:49][47.3]
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Dr Phyllis Nsiah-Kumi: [00:00:50] Thank you so much for inviting me to participate in this conversation. And I agree with you wholeheartedly. As information that's available to patients multiplies in volume, I often find that women come to me and say, how can I tell if this is actually good information? And so identifying good information and knowing what to do with it, being able to engage well with your healthcare team in ways that, you know, sometimes it's tricky, right? Sometimes it's a challenge, but being able to engage and being able, like you said, to cut through the noise, because over time, the volume of information has grown, but the ability that our patients have to use it well doesn't always match pace.  [00:01:29][38.2]
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Dr Louise Newson: [00:01:29] No, you're absolutely right. I mean, when I trained as a doctor, there was no internet, we had no mobile phones. There was no social media and I started actually doing some medical writing as a student. I started to write some information for people who had breast cancer. And I realised that people didn't know what cancer meant. They thought it was death. They thought chemotherapy meant hair loss. They didn't even know really basic things that as doctors we'd learn really early on. And then I realised the importance of language, but the importance of readability, reading ease, allowing people to really understand very short sentences, you know, small words, not to be patronising, but actually to enable them to understand. And I think often with medical literature, it's very complicated. And then people don't understand. And I was thinking about this the other day, actually, because last time I went into an American supermarket, there was a section for meat, and it was hormone-free meat. And it's, we don't really get that so much over here, but people are scared of hormones and it made me think actually hormone-free meat means that hormones are bad and what they're really saying is synthetic hormones in meat, not pure hormones. So even that word hormone causes a lot of confusion, doesn't it?  [00:02:45][76.1]
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Dr Phyllis Nsiah-Kumi: [00:02:47] It sure does, it sure does. And I think at the beginning of every conversation, one of the things I try hard to do is assess what the patient understands. And then as we have our conversation at the very end to have them tell me what we talked about. And so, you know, I like to say, if you had to go home and tell your grandmother what we've talked about today, what would you tell her? Because that's a great chance to understand how they're comprehending what you just discussed. Because honestly, if you say, do you understand? 90% of the time, or more, they'll say yes, even if they don't, because it's embarrassing to be the person who doesn't understand. And so rather than asking, do you understand, saying, what do you understand about what we talked about? How would you tell your family about what we discussed? What are you going to do next? [00:03:27][40.5]
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Dr Louise Newson: [00:03:29] Important because the art of communication, because our consultations are an art as well as a science, aren't they? The whole thing about medicine is being able to personalise and individualise care. Even before people come in the clinic, they fill out a questionnaire. One of the first things we ask them is, what are the top three things you want to get out of this consultation? And that's really useful, actually, because what I think woman wants to get out of her consultation. Might not be what the woman really wants because often she's worrying about something that she might not even bring up or I might not ask but it will be the thing that's on her mind throughout the consultation and then she'll never listen to the rest of the consultation.  [00:04:09][39.9]
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Dr Phyllis Nsiah-Kumi: [00:04:11] Exactly. And I send my patients a, you know, a prep sheet that same way, lets them prioritise their concerns for this visit. And then at the end, you know, you can have a summary of what you need, what are your action steps, but it, if nothing else, it forces them to identify what they want to talk about. Because so often we're rushing, they're rushing too, right. So it's like, I went from A to B, I dropped my kids off, I ran to the grocery store, got the milk and I skidded into my doctor's appointment two minutes before it started. And when the visit's over, you get to the parking lot and you're like, oh, forgot to ask about this. Or I didn't mention that. So forcing them to even take five to seven minutes to think about, okay, how often do I get in front of this person? What do I need to leave this room not having missed? What do I need to know? What can I not get into the car and realise, now I have to wait three more months to come back. And I think having those kinds of conversations, and I tell people, think about it over time. So doing it for five minutes before you come in is a start, but even keeping a notepad where between visits, you have something in your phone or some way to kind of track, oh. I want to ask about this, oh, I want to ask you about this. You know, you and I have both had experiences where someone gets in front of you and you say, what do you want to talk about? And they just give you that blank face like, well, they told me it was time to come back and talk to you. And then later you'll get online messages or voice messages of things that they hadn't thought about or hadn't remembered during the brief time you had together. And I just love to make the most of the face-to-face time, knowing that I think that's the best way to do the communicating. Obviously we use lots of other forms of communication, but making the most of your visit when you're coming in. Us making the most of the time and making sure they're leaving with the same to-do list that we have in mind is really important. Because I've absolutely had people repeat back the to-do list, I'm like, oh dear, that's not what we talked about at all. Let's try again.  [00:05:51][100.6]
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Dr Louise Newson: [00:05:53] It's really important and you know we see a lot of women who have been let down by other healthcare professionals and it's really sad actually but it's also quite revealing because sometimes people ask things that they're too embarrassed or they've been closed down to talk about with other clinicians and sometimes it's quite intimate things. I remember ages ago there was a lady of mine who had a vaginal cancer, she was quite young, she'd had radiotherapy, she'd had surgery and she was really struggling with a lot of vulva and vaginal pain and discomfort and urinary tract symptoms and I offered to examine her and she said, are you sure you can do that? Is that all right? And I was like, of course it is, I'm a doctor, what do you mean? She said, well, none of the doctors before have ever offered and I was too scared to ask because it's so painful and so uncomfortable and I know she had a lot radiotherapy scarring so she knew that it looked different. But I thought, gosh, that's really interesting, isn't it that, you know, some things that are, for me, you just take for granted, but I'd always ask someone if they're happy for me, you know are you, you wouldn't just say to someone, lie down and I'm going to examine you.  [00:07:05][72.0]
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Dr Phyllis Nsiah-Kumi: [00:07:05] Absolutely.  [00:07:05][0.0]
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Dr Louise Newson: [00:07:07] And it just made me realise that, you know, in my mind, especially if they go to a clinic, she'd been under gynaecologists in a clinic. I thought it was a sort of foregone conclusion that it would be examined, but obviously it never came up in the conversation and she never really had felt confident enough to ask and it just made me feel how isolated a lot of people can be especially if they go on their own. It's a very vulnerable situation isn't it to put yourself in front of a doctor maybe that you don't know very well and you're quite quickly telling them things that often you've not told other people as well.  [00:07:41][34.8]
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Dr Phyllis Nsiah-Kumi: [00:07:43] No, I agree. Having someone to support you is great in and outside of the exam room. And so I appreciate your point about asking permission. But I too have absolutely had patients who wanted to be examined. I actually had a patient who had gone to another visit and who requested to be examined and the person told her, I know what the problem is. And so, I'm just going to prescribe you this...here and you're going to go home. And so she stayed in the emergency room all night long and then came to see me that afternoon at three o'clock. So she sat in the hospital for over 12 hours because she was unable to get an exam and she wanted to be sure that the diagnosis was correct. And this physician said, no, I know what you have. And she said, well, I asked him if he would check. And he said, no, I already know what it is, and wrote the prescription and kind of just left her in the room. And so she reported being so kind of crushed by that experience. But I think one of the things that we absolutely encounter as physicians taking care anyone, but especially taking care of women in midlife, is you meet people who have been wounded or brushed off or they give their symptoms and are told, oh, well, that's just kind of goes with the age. So you just have to get used to it. And so they're not offered good discussions, good treatment options, you know, support, coaching, all of these things we have that can help. They're told, well it's just like that sometimes and you know that's how it goes. And you know so often we see people who are at their third, fourth, or fifth stop, you where it was just like I've been trying for years to get an answer. No-one will tell me what this is or everybody says it's just that way and this is how I have to live. And so that's been something that I've seen repeatedly. So I've been really excited to work on some new programmes and educational materials to encourage women in midlife to advocate for themselves, to speak up, to keep asking the questions.  [00:09:27][104.0]
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Dr Louise Newson: [00:09:29] Yeah it's quite surprising isn't it and I don't know whether it's just because I expose myself more in the public and I'm listening to more women but when I was a junior doctor I never heard people saying that they weren't listened to or they weren't believed or they weren't understood. Whereas I hear it every day on my social media at my clinical practice that women are just being dismissed and whether it is because women have got more knowledge that they, they're not fobbed off or whether the doctors don't have the same training and education, or they're just treating people differently. I find it really upsetting and very sad actually, because as a doctor you can't know everything. It's impossible. There's lots of things we don't even know and we might not know for many decades or whatever. But I was taught, and I'm sure you were very early on, is that you have to believe and understand your patients and that most of the diagnosis making is in the history. You have to ask the right questions. But also as a doctor, you have to deal with uncertainty and I'm very comfortable saying to a patient, I'm not sure what's causing your symptoms. And even when they come with very obvious symptoms of hormonal imbalance, so they've got the joint pains, they've got palpitations, they've got night sweats, they have got memory problems, mood problems, I every day say to them, I cannot tell you that these are definitely due to hormonal imbalances. I can tell I think that they are and I'm going to balance your hormones in a physiological way, and then we can see how they improve. But I think as a doctor, you can't say categorically what the symptoms are. And we can sometimes get things wrong as well, but that's okay, isn't it?  [00:11:09][100.8]
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Dr Phyllis Nsiah-Kumi: [00:11:11] It absolutely is and I think that transparency with patients really goes a long way because I think patients realise that we are human and if we pretend otherwise, that doesn't strengthen their trust in us.  [00:11:24][13.4]
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Dr Louise Newson: [00:11:24] No.  [00:11:24][0.0]
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Dr Phyllis Nsiah-Kumi: [00:11:25] And so I think I've had so many patients say, oh, I'm so relieved that you told me that. Because often people say, Oh, that's just how it is. That doesn't mean that's how it, it honestly sometimes means that they don't know and they don't know what to do. And rather than own that, they dismiss you. And so I've told many people, if someone tells you that's just how it is and you ask again and can't get a good answer, ask someone else, because it's quite possible that that person is not in a space where they know enough to help you in that specific area. And hormonal imbalance can overlap with so many other things that making that the blanket statement can be very dangerous for the patients, right. So we want to make sure we do a thorough look at everything, which involves asking questions, taking our time and actually listening when they talk.  [00:12:07][42.1]
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Dr Louise Newson: [00:12:08] Yes,.  [00:12:08][0.0]
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Dr Phyllis Nsiah-Kumi: [00:12:09] We've all been in a room where someone asks the question and moves right on past you while you're still answering.  [00:12:12][3.6]
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Dr Louise Newson: [00:12:14] It's so interesting, isn't it, because I often think about the difference between or signs that we can see and symptoms that patients experience. And the other day my daughter was showing me a rash that she had and she'd recently had a viral infection, so it was probably a viral rash. And I said, I don't know what it is, but it doesn't need anything that, doesn't look like anything that needs a specific treatment, it will probably settle. But I could see the marks on her skin, she had a rash. So I couldn't say, well, there's nothing wrong because there was a mark there. But that's very different when it's symptoms that people experience. Because how I'm experiencing the symptom, even if it's a physical symptom like a palpitation, but certainly when it is a mental health symptom, it's so much easier to dismiss as another person because you can't see it. And I think that's what happens a lot with symptoms of hormonal imbalance because you can't see them. You can't do a test to show it. I can't do a brain scan and show that this person has low hormones in their brain causing their low mood and anxiety and overthinking and whatever. So it's so much easier just to say, well, it's not really there.  [00:13:24][70.3]
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Dr Phyllis Nsiah-Kumi: [00:13:24] Yeah, and one of the things that I've been doing with my patients that I found very helpful is when it comes to their symptom groupings to have them fill out one of the standardised assessments. So in addition to kind of a symptom tracker at home, when you come in, we can kind of categorise in each of these areas how your symptoms are. And just as you said, we can't scan everyone's brain and check all their hormone receptors, but we can know how they're experiencing those symptoms. So if today you're saying when it comes to fatigue, I'm on a scale of one to ten, I think I'm about a ten, or I'm an eight. And the next time you come, you say you're a three, you can be your own baseline, and we can say, okay, so you are not feeling well, even if there's not a measurement that I can do in the lab that tells me what to do, but it helps me address what's happening. And so I think managing symptoms, like you're saying, as well as managing the actual objective things we can measure are important, but it seems that in midlife, the subjective things get much bigger. And so then it's much easier to say, well, all these tests, we didn't see anything. So, you know, I hope you feel better. Come back six months or we'll see you next year. Versus saying, we need to dig in deep to the symptoms because having people suffer is, you know, we came to do no harm. And so having people suffering and just leaving them blowing in the breeze is, to me, something that is unacceptable. And, so many women come to us and that's been their experience.  [00:14:40][75.6]
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Dr Louise Newson: [00:14:42] I absolutely agree. I mean, the suffering is so immense. And we extended our symptom questionnaire. It's the same one that's on Balance app and on my website. It has got 84 symptoms. And when we first did it, a lot of our doctors who worked with us said, oh, no, it's going to take ages and the patients won't enjoy it. But actually, a lady said to me the other day, I feel validated filling out your questionnaire. I feel heard. I feel listened to. And I was saying, well, that's interesting because It's just a tick box, but I think because it has so many symptoms. And one of the questions about symptoms is, do you feel like yourself? And it's that, you know, it's a very, it's not a clinical thing, is it. But a lot of people feel that they just do not feel themselves anymore. And to be able to admit that and know that you're not the only person feeling like that, I think that's really validating as well, actually, isn't it?  [00:15:32][50.7]
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Dr Phyllis Nsiah-Kumi: [00:15:34] Absolutely. I actually just held a webinar yesterday with a group of perimenopausal and menopausal women. And so we had the anonymous things where you use your phone and the QR code and you vote. And so you don't have to give your personal answer, but you see the response of the group in general. And so the feedback I received was absolutely like, I thought it was just me. I didn't know other people were feeling this way. Nobody ever asked me that question before. So if they're not feeling comfortable enough to take the question forward themselves to their doctor, or their healthcare team. And those people in turn don't ask them as you do so thoroughly, then they're left. It's like them and Dr google and they're all alone. So being in a room full of people, even just to hear it's not just me. I like forgot in the middle of a presentation what I was even saying. Oh, you know, I lost this and you know I have this shoulder pain and just hearing that other people are having the same experiences goes so far. And so one of the things for sure that we are incorporating into our programme is you know, support groups, but even coaching, having someone talk with you through those symptoms that you experienced that no lab test is going to quantify goes a long way. I think people start to feel better when they realise they're not alone.  [00:16:41][67.2]
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Dr Louise Newson: [00:16:42] I think so. I think what's really changed over the last few years as well is that women are really helping each other. And a lot of times they haven't had the right knowledge or information, but when they do, it's made a massive difference. And you know, I've never advertised my clinic or my services at all. But when I started on my own, I only was working one day a week doing a hormone clinic. That was all I wanted to do. And then women started to talk and say, well, actually you shouldn't be experiencing all these symptoms because they're probably related to your hormones. Why don't you think about having hormone treatment? But before that, they've only ever got their information from their doctor who was telling them, no, the only treatment was an antidepressant. So actually it's a weird imbalance because it wasn't like this when I was at medical school that women are learning from their peers more than they are from the healthcare professionals. And some doctors find that really challenging. But I actually really like it. There are sometimes people come, and I'm sure people have come to you with completely ridiculous ideas because they've read in the newspaper, a study of one person has found this cure for Parkinson's disease, and they want that treatment for their grandfather or something, and you have to unpick it and explain. But actually, I think what is great is they're learning about testosterone and how it works throughout the body, and they're really keen to have a blood test and maybe try it because, you know, and I think that's great to be involved in that conversation as well, isn't it? [00:18:11][88.8]
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Dr Phyllis Nsiah-Kumi: [00:18:12] It is, I find that if you are a doctor that is not ready to do hard work or heavy lifting, it can be very challenging because it keeps us on our toes. Every day you walk in and you're like, ooh, what interesting thing am I going to hear today? And sometimes it's real and sometimes it is not and, you know, when you go online, you absolutely find groups of 5, 10, 20,000 women and I was in one group just poking around and there was a woman who said, I went to my doctor who gave me this medicine in this dose. What do you think? Should I take it? And like, you're crowdsourcing 5,000 strangers about medical care when you just left your doctor's office. And so, no doubt that person went back and said, well, the group says I shouldn't take it. And so obviously, crowdsourcing your health care decisions is far from ideal. But us knowing that they're investigating, they're reading, they are asking each other, and they're willing to then engage with us, it still gives us an opportunity to kind of maybe right the balance of some of those things that are a little bit inaccurate, but to have the conversations and keep it open as a safe space. So it's not that once you've Googled anything, then don't ever come back to me. Because I saw one of these memes and it says, if your first opinion came from Chat GPT, you should get your second opinion from Claude. As in if you're looking elsewhere for information, you're not welcome here. And I mean, it adds to the complexity of what we do, but it gives us a chance to help our patients get to the next level. And I would rather an engaged patient who is reading and asking questions every day of the week, than someone who shows up and says, I don't know what I need, whatever you say, whatever you say, because we want patients that are engaged.  [00:19:44][92.5]
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Dr Louise Newson: [00:19:46] I totally agree and it's really important when I was training to be a family physician, a GP, my trainer was very good at educating me to how to ask the patient, what do you want out of the consultation? Why are you here? And I said to him, if I ask those questions, they'll think I don't know what I'm talking about. He said, no, honestly, it will make such a difference to your consultation. And I think it's so important. But one of the things that worries me is how we reach other people, like there's so many people, I mean every woman has a hormone imbalance and a lot of women are dismissed, but a lot of women who don't have English as a first language, they have different ethnicities, they're harder to reach groups, these women are often are learning from each other but they're not having anyone else to give them the right information, or they have relatives that have never taken hormone treatment. So they said, well, my mother, my grandmother didn't have them. So why would I think about this? And it's how we change those conversations really, I think it's really, really important. And also those conversations, not just for the women, but the doctors working in those environments, because they often don't see hormone treatments as a priority. They're thinking about blood pressure and mental health symptoms and treatments and everything else and it's, how do you think we should change that conversation?  [00:21:08][82.2]
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Dr Phyllis Nsiah-Kumi: [00:21:10] I think that it's definitely a tough conversation and I spent a large part of my career working with underserved communities. So when it comes to language, race, ethnicity, all kinds of things, and the conversations are different, but they have to be intentional because as you're saying, people, you know, any patient might come in and say, well, I guess I should take my blood pressure pill, but then I got to go to work and do, like learning about hormones and what that impact could be on their lives is not always their priority. So I think we have to take the information to them. And so when it comes to any work in communities that are maybe not the mainstream community. We need to find where they are, meet them where they are. I mean, things that I've done in the past when it comes to breast health and, you know, midlife women's health are to host events either online, in person, which takes a different kind of effort, right. So aside from your clinic visits, if you don't reach people outside of the clinic space, they may not come into the clinic space to have those conversations to begin with. So, you, know, hosting events, participating in events for the community where they're talking about health in general. You can be the one booth and talk about midlife women's health, and even just a few brief conversations gets it started. Because as we said, women talk to each other. So someone who comes to your event and hears a coffee talk or a lunch and learn or something, like, you know, I learned all these interesting things and I got this information sheet. And again, making sure that the way the information is delivered is something that they're comfortable with and it meets them where they are. So if we're talking about issues of language, it needs to be written in the appropriate language at the appropriate grade level. It needs to be fully accessible so that once they receive the information, they know what to do next. And that takes work. And not everyone's willing to do that work and not every system is readily equipped to do it. And so I think making sure that you find places and spaces that keep special populations in mind gives us a chance to do this really hard but important work for more people. But I think we have to be intentional. We have to identify the needs of the community. We have to find who are the key stakeholders in those communities and engage them in the dialogue, and they bring people along. Absolutely, in my experience doing work in the community, there are things you can do alone, but you do better when you find community groups that all of the women in that particular community trust and things like that. But it takes work, it takes effort, and it takes conversations where we get to know each other, they get to trust you, you get to understand what they need. And they'll say to you, We understand you want to talk about midlife hormone health, but honestly, our community has questions about diabetes. Now, it's easy to say, well, I didn't come to talk about diabetes, but if you don't talk about diabetes, you won't get to talk about anything because they won't invite you in. So that piece where you identified their needs, just like we do in clinic visits is so important. And then it gives us the open door to talk other things, right. Then it becomes, oh, Doc Kumi, what else do you have that you can teach us? Or how can I tell my mother or my sister about this? But you have to show up and earn trust. Sometimes they'll take you with your topic. Sometimes there's something they believe that they need more. And so if you offer them what they believe they need the most right now, you then are buying yourself a little goodwill and a little of an open door to then say, here's what else I have to offer that I think is really important. How can I help you all feel your very best, be as healthy as possible, reduce the risk of long-term health problems. So it starts with a single conversation, but it starts with intentionality.  [00:24:23][192.9]
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Dr Louise Newson: [00:24:24] Yeah I really like that and that's so true because a lot of the time when I speak to women they actually, once I start talking about the impact of hormonal changes on their children, a lot them have got children in their teens or their early 20s, a lot of them have been diagnosed with endometriosis or PMS or they're struggling and then the conversation shifts quite quickly to their children. I think it's really important because as doctors, we should be very holistic. We should be flexible in the way that we work. And because hormones affect every cell, every tissue organ in the body, we can't be just talking about periods. We can't just be talking about palpitations. We have to be thinking about the whole body and mind and the effects. And that's when the conversations get more interesting as well because people can ask all sorts of questions, which is so important, isn't it?  [00:25:16][52.2]
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Dr Phyllis Nsiah-Kumi: [00:25:18] It absolutely is, and I would add to that, that in addition to having a holistic approach to physical health and to mental health, understanding the psychosocial model, just like you mentioned, people are interested when you raise their children as part of the conversation, women may be struggling and the other people in their corner, if they have partners or friends or family members, those people don't have the language to talk about it either. So I'm struggling, I don't know how to describe it, you're watching me struggle, You don't know how to describe it. You'll probably try to help and maybe ask the wrong question. So now I'm upset and the conversation's over. So we've been creating resources that also are good for whoever's in a woman's corner as she wrestles through. So being prepared for the next generation, how you interact with your children, how they are feeling about all of these life stages and changes is important. But then how do you interact with your co-workers, with your family and friends, the people who will cheer for you every day of the week twice on Sunday and want you to be your very best at everything. How do we communicate with those people as well? Because even though they're not our patients, they are part of the story, right, they're a part of how this woman is gonna achieve her very best health in a season fraught with, you know, hormonal fluctuations and ups and downs. When you are feeling whichever way you're feeling on Monday versus Friday, you're not in the universe alone. You've got your family, your friends, your co-workers. And so you want the people who want to support you to also have some information. It's not their job to fix you. But having some resources and some language to be able to say, you know, how can I help you? You know, it seems like this, how could I help? And we've got a great tool we're working on that gives you the chance as you kind of can lay out your symptoms and talk about with your doctor. If you wish to share that with someone, you can share specific symptoms and it gives them very specific language about how to talk about this, things never to say and things like that, because then it helps make the conversations feel a little safer. Just like the patients are scared to talk to us sometimes. Someone who's on the outside looking in, is also nervous about making a mistake and making something hard worse. And so what ends up happening is silence.  [00:27:18][119.8]
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Dr Louise Newson: [00:27:19] Yes, yes, that's absolutely right and I think the more people can advocate for each other as well, then then that makes such a difference when people come together to consultations whether it's a sometimes it's the daughters actually that come with the mothers because they're worried about the mother, could be partners. It's, you know, that that really makes a huge difference and the more we can do that and the better I think because, you know, having someone else who's really there invested in that person, those people are more likely to remember the consultation, they're more likely consider taking any treatment that's prescribed and they'll be able to share the benefits as well because it's very difficult when you're having, especially a hormonal imbalance because when you live with yourself 24-7, you can normalise a lot of symptoms and think, oh, it's because I'm stressed, because I'm busy, because I'm... And sometimes you need someone external to say, Louise, no, I've seen you stressed before, this is not you, this is something different. I think you should go. And that's really important, isn't it?  [00:28:21][62.7]
Dr Phyllis Nsiah-Kumi: [00:28:22] It absolutely is. It makes a huge difference to know that you're not alone and that there are people in your corner who want to help you through a very challenging season. That for so many women for so long has been a black box, right. We get there, what's happening? What's going on? Does anybody know what this is? And so you don't know what it is. But now you have someone who's willing to walk with you through that slightly dark zone and come out the other side. You've got resources and amazing physicians like yourself. We want to help our patients get to the next place. And when they come with someone who feels the same. I think they feel supported and will have better outcomes when it comes to making any behaviour change, just normalising talking about it even, right? Just being able to say, this is a rough day because versus, oh, this horrible thing is happening to me. I can't talk to anybody else. I'm not going talk to my doctor. I'm going suffer in silence or talk to myself about it. But creating spaces for really important and sometimes uncomfortable conversations goes so far, I think, in helping each of us grow.  [00:29:19][56.5]
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Dr Louise Newson: [00:29:20] Yes, that's so important. So to finish, I just always ask for three take-home tips, and I'd really like to ask if someone's listening to this and they're worried about a partner, a work colleague, a friend, and they want to advocate with them and for them and take them to the consultation, what are the three things you think they can learn or help to really support this person who's struggling?  [00:29:45][25.2]
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Dr Phyllis Nsiah-Kumi: [00:29:45] Yeah. So for our programme, we talk about pausing, pivoting, and proactivate. So pause and see where you are right now.  [00:29:51][6.0]
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Dr Louise Newson: [00:29:52] Yes.  [00:29:52][0.0]
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Dr Phyllis Nsiah-Kumi: [00:29:53] Pivot and decide, I have to live this way is not the option. And the option is what can I do to have a better life? What can I do differently? What is available to me? And then proactivate is that piece where you take active steps. And it starts with getting the information, right? So ask good questions. You know, what is, what is what you've told me mean for me? What are all of my options? What happens if I don't do any of the things we've talked about today? So patients get to decide whether they will or won't take on the treatments that we offer, but making sure that they have all the information available helps us know they're as informed of patients as possible. And then in the same way, we're not just teaching them lots of big long words. We are teaching them information that they can use. So I would tell both patients and whoever's in their corner, we pause, we pivot, and we proactive.  [00:30:43][50.8]
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Dr Louise Newson: [00:30:44] Oh, I like that. Very, very good. What a great way to end. Thank you so much for your time today. It's been really wonderful.  [00:30:50][6.0]
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Dr Phyllis Nsiah-Kumi: [00:30:51] It's been wonderful to meet you as well. I've heard so many lovely things. So this really was quite an honour and I've loved chatting with you. And I hope that someday we get to talk again.  [00:30:51][0.0]