From Mistake to Mastery: A Genetic Counsellor’s Story. Demystifying Genetics with Rachel Vanneste (Favourite gene SHH)

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This is Demystifying Genetics. I am your host, Matt Burgess.
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In this episode, I'm joined by Canadian genetic counsellor, Rachel Van Est.
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We talk about the value of volunteering within our profession,
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take a light-hearted dive into the sonic hedgehog gene, and discuss why sales
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and business skills are becoming increasingly important in genetic counselling.
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Hello and welcome to the podcast. Thank you.
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How's it going? I am very excited to be here. I'm good. Well,
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I'm so excited to have you on my podcast.
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And one of the things that I wanted to chat about was we have something in common.
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We both had articles published in a special edition of the Journal of Genetic Counseling.
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And I went back and read your article and it was really interesting.
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So, it was where you spoke about a mistake that you made as a genetic counsellor.
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And obviously, this was a long time ago, over a decade ago, and now you're a
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senior genetic counsellor and you've published and you're involved in lots of different things.
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I'm just wondering, when you look back, how you feel about the article and how
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you think that you've changed since then?
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You really do your homework because that's going way back. So that was at the
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very beginning of my career where I felt that I had made this very big mistake and.
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Probably felt a lot of shame around that mistake and
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one of the ways that i try to combat shame is
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by talking about it and telling my story so baby genetic counselor rachel thought
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that if i wrote this up for that special issue and shared the experience with
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a whole bunch of others that i could kind of take that power away from it thinking
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back to like i was i think second year in my career. I was very new.
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And so I'm proud of the early genetic counselor that I was, that I felt strong
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enough to basically share my worst genetic counseling experience with other readers.
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And then I also got to use that example to teach students.
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So for one of the courses, we would talk about role-playing and different things.
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And I would use that case as a way to help people
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or the students work through difficult situations so
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and was it successful like
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when you published it and gave it to the world did
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it take away some of those feelings of sort of guilt or shame it did it was
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out there and it was like no longer just mine it was the world's at that point
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so yes it did not hold the same amount of power over me once it was published
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so i mean i hope you don't mind if we chat a little bit about it,
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but as genetic counselling students, we're healthcare professionals.
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Well, we're learning to be healthcare professionals. And, you know,
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one of the fundamental things in healthcare is not breaking confidentiality.
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And, you know, we all have like a good idea of what that means.
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But I think in genetics, like things can be a little bit nuanced or a bit more
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complicated and sort of,
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you know, you speak in your case about how you accidentally revealed
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something that the female
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partner had said that the her partner the
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male partner didn't know and in the grand scheme
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of things it probably wasn't the worst kind
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of sort of breaking confidentiality that we can
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see happen but you know still on the other hand like it was upsetting to the
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patient and how like when you're talking to your students do you feel like they
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sort of are able to understand sort of what an effect it had on you and,
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you hope that they don't have to go through something like that?
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I think in sharing that story with them, I wanted to be open that even once
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you graduate and are a practicing genetic counselor, you can and you will still
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make mistakes and you will survive and it will be okay.
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So it was less about, it was more about taking the fear away from them that
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like, oh my gosh, I can never make a mistake again once I've graduated and I
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have to know everything and that's just not the case.
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That there is still room to grow and learn even once they've started their careers.
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Yeah. It's funny, like I didn't put so much pressure on myself about learning
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to be a good genetic counselor from the course. I put all of that on the process
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of becoming board certified.
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And I really thought as soon as I'm board certified, like I will be perfect.
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Like all of the genetic counselors that are board certified, like
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it's such a process in Australia or New
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Zealand and you know like we will be amazing
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as soon as that happens we will be perfect and it's
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like oh okay that's that's not the case like maybe i
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sort of had boosted it up a little bit and you
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know we're still human and we still make mistakes well i think that speaks a
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lot to the differences of the training back when you went through the program
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back when i went through the program compared to today i think current day programs
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internationally are starting to look more aligned with the north american model
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but when you went through your program in australia.
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It did look a lot different than some of the north american training
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programs because we were supposed we had done i think
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more clinical exposure we were supposed to hit the
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ground running you were on your way and the
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board exam well the board certification was an exam it
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wasn't the full process you've gone through with
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the supervision and the long cases and the reflections and
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recordings and so i think that does give
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you the experience to feel like you are growing as a genetic counselor
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where it felt for us upon graduation that
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it's like and you must know everything yeah yes so the article that i had published
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in that special issue of the Journal of Genetic Counseling was actually about my last long case.
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So, for my certification, and it's sort of changed now, and this,
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you know, I became board certified in 2009. So, it's a long time ago. I'm trying to remember.
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But I think we had to write 20 long cases, 100 short cases, and have ongoing supervision.
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And I think my short cases were about a page long, and my long cases were,
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I think, about 9,000 words. So, yeah.
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It was a lot. And, you know, like I put so much effort into it and lots of thought
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and, you know, they were well referenced.
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But, yeah, my last case was interesting and it's something that I want to talk
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to you about because it was about counselling somebody in my second language.
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So, I did French at school.
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You know, I'm a big Francophile. I was an exchange student to France.
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I then did five years of French at university. I did a little bit of interpreting
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training, but my French isn't perfect.
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You know, I can sort of get by.
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And I felt like it was nowhere near at the level to practice genetic counselling in.
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And before I learned French, I thought that fluency was like you either have it or you don't.
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And now I realize it's a spectrum. It's on a scale. Yes.
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And it was interesting because I had a lady from overseas that was referred
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because she had a strong family history of breast cancer and a personal history.
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And it was when I was in Sydney, she was having testing.
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And so, for the first, I think for
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the intake, when I organized the appointment, I spoke to her in French.
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And that was fine. I drew the family tree. and then
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for her first appointment in person
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um i had the interpreter present and
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it was very interesting hearing because she interpreted everything
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and i'm not sure if she did that because she knew that
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i could tell what was going on but yeah every
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kind of uh um or what i mean to say is oh uh she said it all and then for the
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results appointment the interpreter cancelled last minute and my patient was
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going back overseas the following day and I couldn't get a phone interpreter.
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And I said to the geneticist who I was working with, like, I think I just have to do it in French.
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Like we have to give the result and it has to be now.
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And it was really interesting because like the clinical geneticist just was
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annoying me. He kept saying, oh, make sure you say this and say this.
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And it's like, I've already said
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that. I just said that because he didn't understand what was going on.
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And, you know, there were some things I couldn't say, or I could sort of get there in the end.
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But I remember saying to her, like, this is your appointment and this is really
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important information.
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And I'm so sorry that I'm not able to explain it.
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As well as I could in English, but I hope it's okay.
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And like her and she brought a support person, they both didn't speak English
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and they both said, Matt, you did a great job. We understand everything.
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So that was sort of my little example of counselling in my second language.
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What is it about language that fascinates you or that interests you as a genetic
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counsellor and sort of different languages?
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So as a Canadian, our country's official languages are French and English.
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And so most major cities in Canada, when you're put into public school,
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you can be put in the English system, but you can also be put in French immersion.
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And so starting in kindergarten through all the way of grade 12,
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I was in French immersion. So this meant that math, science,
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history, all of that, I was taught in French.
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So in the prairies where I grew up, I would have considered myself bilingual.
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But then I moved to Quebec to do my program at McGill and realized,
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oh, the people of Quebec might not consider me as bilingual as maybe the people in the prairies do.
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But I was still able to counsel and communicate in French.
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But I quickly realized that there was an extra layer of complexity in both training
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and then eventually working in my second language because you're a first-year
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student, you're just like, okay, how am I going to take this pedigree?
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And so then I would, you know, you figure out the pedigree and then you're like,
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okay, now I have to make sure I have all of those conditions and all of those
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distant family nomenclature memorized as well.
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And there are a lot of terms in genetics and medicine that you would never have
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learned in school. They're not just part of the curriculum. And so,
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preparing the night before to make sure I had all the correct terminology.
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So it just added an extra layer of stress. It also gave me a wonderful experience
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that compared to my Anglophone classmates, I got to see twice as many patients
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because I could see both the English and the French patients.
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So it definitely enriched my training and every patient I had who was French
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speaking was so kind and considerate about my accent and my mistakes and things like that.
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But overall, I think there was a need to appreciate the extra labor that is
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done when you are counseling and or learning in a second language.
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And so that's why my master's project, my second year project,
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was the experience of genetic counselor trainees and supervisors when a second
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language is put into the mix.
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So yeah, that's kind of where it came out of a personal experience.
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Oh I'm having trouble with this I wonder if other people are
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too so so how difficult was it
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like when you sort of turned up to study at
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McGill like obviously when you applied you probably
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thought that it'd be fine but then once you started was it like oh my god like
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this is so much harder than I expected or the the first time I was ever like
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it was the second month of the program it was the first time I was ever going
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to speak to a patient and it just has so happened to be a French-speaking patient and I.
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I bombed. Like, I couldn't find the words I told. Like, I was nervous because I was new.
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And then adding that second language, it all fell apart very quickly.
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And so I think that very first time trying to explain autosomal recessive inheritance
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in French and failing so miserably made me realize how much extra work I needed
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to do on top of it until I had a good grasp of the genetics jargon in French.
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Yeah, because that's difficult. Because even, you know, in your native language,
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when you have to speak to a patient for the first time and explain something,
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that is really sort of overwhelming.
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So, you know. I can still feel the way my face just like flashed and I was just
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like, oh, this is the worst.
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Oh, golly. so i when
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i have guests on the podcast i
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always ask them what their favorite gene is and what
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their favorite condition is and you said that your favorite gene was shh so
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let's chat about that it's not a different time i sort of talk about very often
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how did you pick this one or what how come this is your favorite?
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In my undergrad, when I was doing biochemistry and molecular genetics.
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It was a gene that we learned about in like a third or fourth year class.
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And there was just something about loving the lack of seriousness of naming
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such an important gene in terms of like patterning, sonic hedgehog.
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Like I just loved the geekiness with something so scientific and serious and
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so i i think i enjoy it for that reason that there is still kind of that sense
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of humor in science okay it's funny because i um.
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My husband Danny and I just watched an episode
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of RuPaul's Drag Race and the
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song that the queens were lip syncing to
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at the end was Never Gonna Give You Up by
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Rick Ashley and my level of pop culture knowledge is much higher than dance
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so he didn't understand like the phenomenon like the memes of this you know
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this song and like rickrolling and how it's sort of in popular culture I was like, yeah,
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you know, there were people that write essays and the essays make sense.
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But then when you, you know, there's a pattern and it's got the lyrics of the song,
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you know, I just was reading it on Wikipedia and someone had done like a literature
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review of the actual link of the song,
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you know, like the URL for the YouTube clip of the song.
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And that's been published over 20 times in real articles.
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So a lot of the times it's just in the footnotes, but it kind of is like, on one hand, you can.
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Write about something really kind of serious and sort of show the appropriate,
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you know, reverence, but then you can still kind of have fun as well.
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So with yeah this sonic hedgehog gene
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like have you seen patients or
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like have you counseled about it as well i haven't
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but in learning about sonic hedgehog and some of the other patterning genes
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that really cemented in me like the why i love genetics right the the way that
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it starts in early embryological development and the patterning required and it just,
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It really highlighted to me what I love about genetics from like the scientific perspective.
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I don't think I've ever counseled with respect to that.
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But it just, it kind of was just the cementing figure of my love for genetics.
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Yeah. Oh, it's so funny. We're both so nerdy.
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Yeah. You know, like it's involved with Holland Prose and Cephali and it's sort of,
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yeah, I remember as a student learning that it was something I hadn't really
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thought of before, but I kind of was like, okay, we all kind of get that a gene
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is like a recipe or a code for something that our body needs.
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And I just thought that that recipe was always available or was always turned on.
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But then there's sort of like this idea of like developmental genes and they
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only come on at a specific time for when our body needs it.
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And like to think of like a human baby sort of developing, you know,
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I think that this gene gets turned on at about week three or four and then the brain develops.
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And if there's a mistake at that time, that's where the brain development can happen.
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But yeah, it's complicated. Yes, and I love it.
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Now, how is your PhD going? Oh, my gosh.
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So slow and so steady. But going back to do a doctoral degree in your 40s when
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it's totally different than doing it in your 20s.
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Like I recall my friends who were pursuing PhDs in our 20s and really finishing
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this PhD was like, I have to finish. I can start.
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The next phase of my life and going back to do doctoral degree in like my mid to late career,
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when i'm doing this more for the
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enjoyment of research and learning how to do this properly and not having an
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entire career riding on the back end of it means that i'm totally okay just
00:18:14.090 --> 00:18:21.630
chipping away at it very slowly i would like to ask you about the reason that you chose this topic
00:18:21.750 --> 00:18:28.970
so it's lovely that you're in a position where you can you know you can do a phd because you.
00:18:29.690 --> 00:18:32.410
You know at the point in your career where you'd really
00:18:32.410 --> 00:18:35.270
like to study some more or you can learn about this topic
00:18:35.270 --> 00:18:38.190
and you know do a deep dive and it's not because you
00:18:38.190 --> 00:18:41.510
have to so your topic is genetic counseling
00:18:41.510 --> 00:18:44.870
in primary care was this like topics
00:18:44.870 --> 00:18:47.670
that are given to you or was this a topic that
00:18:47.670 --> 00:18:50.650
was of great interest or yeah
00:18:50.650 --> 00:18:54.610
how did you and this topic find each other well
00:18:54.610 --> 00:18:57.710
this is one of those topics that i just i just
00:18:57.710 --> 00:19:00.690
kept looking in the literature i'm like why hasn't anyone published about this
00:19:00.690 --> 00:19:03.630
yet and while there have over the last
00:19:03.630 --> 00:19:08.770
five ten years like there would be one abstract presented at a conference or
00:19:08.770 --> 00:19:13.090
one small paper coming out and so there'd just be little bread crumbs to this
00:19:13.090 --> 00:19:17.210
larger idea and there there's some really great researchers in the space and
00:19:17.210 --> 00:19:20.790
genetic counselors who are advancing genetic counseling in primary care.
00:19:21.190 --> 00:19:26.310
But at a certain point, I think four years ago, I realized I just kept waiting
00:19:26.310 --> 00:19:31.090
for more and more people to do this, for there to be good evidence that this
00:19:31.090 --> 00:19:34.270
is the effective way of genetic service delivery,
00:19:34.450 --> 00:19:37.710
and realized that maybe I have the time and the bandwidth,
00:19:37.910 --> 00:19:41.970
so maybe I should stop waiting for it just to show up and I should approach that.
00:19:42.150 --> 00:19:47.730
So I spoke to a colleague in primary care and I said, I'm interested in this topic.
00:19:47.890 --> 00:19:51.750
She gave me the name of the head of research of academic family medicine in
00:19:51.750 --> 00:19:53.750
the university in my city.
00:19:54.170 --> 00:19:56.990
I dropped them an email saying, I'm interested in this topic,
00:19:57.030 --> 00:20:00.610
are you? And they're like, within five minutes, I got a response saying, yes, I am.
00:20:00.770 --> 00:20:03.430
And so it was very timely.
00:20:03.670 --> 00:20:09.950
I found a great supervisor right away, and my desire for the doctoral degree was really driven by.
00:20:10.709 --> 00:20:16.829
Wanting to advance genetic counselling in primary care more so than getting a PhD.
00:20:17.289 --> 00:20:22.609
It is something that I have seen people sort of chat about, you know,
00:20:22.709 --> 00:20:27.089
like I don't think I've read many articles about it, but yeah,
00:20:27.209 --> 00:20:30.389
it seems like it is sort of growing in popularity or,
00:20:30.709 --> 00:20:35.109
you know, like at the last conference I went to in Sydney a couple of months ago,
00:20:35.289 --> 00:20:40.109
people were sort of talking about genetic counselling in primary care and I
00:20:40.109 --> 00:20:44.149
was talking to my GC bestie Lucinda and she's like, hang on,
00:20:44.249 --> 00:20:45.949
there's someone in Canada doing this.
00:20:46.509 --> 00:20:53.749
It's Rachel. Yes, it's Rachel. So is there a need for genetic counselling in
00:20:53.749 --> 00:20:55.889
primary care? That is a great question.
00:20:56.649 --> 00:21:01.489
And right away, I'm just going to say yes, but I just am in the process of completing
00:21:01.489 --> 00:21:05.889
a scoping review, looking at what is currently being offered in primary care
00:21:05.889 --> 00:21:10.049
in terms of genetics in Australia, the United Kingdom, New Zealand, and Canada.
00:21:10.289 --> 00:21:16.609
So what are primary care clinicians actively doing right now in terms of genetics care?
00:21:17.209 --> 00:21:25.349
And in Australia, the McKinsey's Mission Project has really been the main focus
00:21:25.349 --> 00:21:27.889
for what's happening in genetics in primary care.
00:21:27.889 --> 00:21:32.169
So right now that is a genetic test that a lot of primary care clinicians are
00:21:32.169 --> 00:21:37.629
offering, but once the results come back, they get referred out. In terms of
00:21:38.049 --> 00:21:42.249
The United Kingdom, they've had, based on what I've seen in the literature,
00:21:42.889 --> 00:21:46.389
they've been doing a lot of work of getting primary care clinicians to order
00:21:46.389 --> 00:21:50.089
familial hypercholesterolemia testing and do cascade testing.
00:21:50.409 --> 00:21:53.929
So if you start to look at some of the cardiology guidelines,
00:21:54.249 --> 00:21:58.169
the obstetrics and gynecology guidelines, more and more guidelines are starting
00:21:58.169 --> 00:22:01.829
to come out saying, hey, primary care, you should take over some of these genetic
00:22:01.829 --> 00:22:03.649
testing that are really common.
00:22:04.689 --> 00:22:08.429
And unfortunately, with the way that the primary care system is right now,
00:22:08.569 --> 00:22:10.409
it is highly overburdened.
00:22:10.689 --> 00:22:13.549
A lot of the clinicians are burnt out.
00:22:13.969 --> 00:22:21.929
So much administrative work and team-based care is becoming kind of the ideal model in primary care.
00:22:22.069 --> 00:22:25.589
And so this would be you have your physicians, you have your nurse practitioners,
00:22:25.589 --> 00:22:30.109
but also on the team, you can have physiotherapists and social workers and dieticians.
00:22:30.109 --> 00:22:34.589
And so in this team-based care, I would really like to see a genetic counselor
00:22:34.589 --> 00:22:39.769
integrated, and we can take the preconception carrier testing off and do the
00:22:39.769 --> 00:22:42.709
cascade testing for promelial hypercholesterolemia,
00:22:43.149 --> 00:22:46.109
none of which is outside of our scope of practice.
00:22:46.829 --> 00:22:51.649
And so it's, one, there's a lot of clinicians still who don't know that we really
00:22:51.649 --> 00:22:53.769
exist or what we do when we're there.
00:22:54.149 --> 00:22:58.329
A lot of them still think you go to a genetic counselor to get genetic testing.
00:22:58.589 --> 00:23:03.269
But I still think that thinking back to early genetic counselor careers,
00:23:03.549 --> 00:23:07.949
when we're talking about a lot of multifactorial condition and it's not just
00:23:07.949 --> 00:23:10.029
testing, it's just a lot of genetic counseling.
00:23:10.329 --> 00:23:14.189
And I think a lot of the work that genetic counselors could do in primary care,
00:23:14.769 --> 00:23:17.069
is kind of going back to those roots.
00:23:17.509 --> 00:23:22.709
So talking about hypermobile EDS, there's no genetic testing for that,
00:23:22.849 --> 00:23:27.549
but being able to spend an hour with those patients to go through their family
00:23:27.549 --> 00:23:29.289
histories, talk about their condition,
00:23:29.849 --> 00:23:32.369
explain that there's not much in terms of genetics to offer them,
00:23:32.489 --> 00:23:37.409
but even giving them that time and space can go a long way to alleviating a
00:23:37.409 --> 00:23:39.769
lot of the anxieties they might have around that.
00:23:40.369 --> 00:23:45.269
Same for psychiatric genetic counseling, the group in British Columbia with Dr.
00:23:45.409 --> 00:23:50.249
J-9 Austin's shown the huge benefits of psychiatric genetic counseling.
00:23:50.449 --> 00:23:55.329
So even being able in primary care to talk to patients with a history of personal
00:23:55.329 --> 00:23:58.609
or family history of mental illness, I think could be highly beneficial.
00:23:58.869 --> 00:24:03.749
So it's kind of reminding a lot of these primary care clinicians that we are not.
00:24:04.236 --> 00:24:08.736
Just the gatekeepers to genetic testing that our counselling skills actually
00:24:08.736 --> 00:24:12.636
can provide benefits to patients even when there's no test to go with it.
00:24:12.876 --> 00:24:17.656
Oh, phew. I'm so glad that you said yes, because I kind of think the answer
00:24:17.656 --> 00:24:23.516
is yes as well, but it would be literature and data sort of out and published
00:24:23.516 --> 00:24:24.856
sort of surrounding that.
00:24:25.056 --> 00:24:30.296
And I say this with love and I really don't mean it to be patronizing.
00:24:30.636 --> 00:24:36.416
But I think that our primary care doctors, our GPs do such a good job.
00:24:36.576 --> 00:24:38.116
You know, it's a hard job.
00:24:38.296 --> 00:24:42.816
They need to be across so many different areas of medicine, you know,
00:24:42.916 --> 00:24:48.816
like even just, you know, diabetes and cholesterol and, you know, like it's just a lot.
00:24:49.016 --> 00:24:51.596
And then to kind of say, oh, no, genetics is easy.
00:24:51.856 --> 00:24:54.996
You know, you just have to order this test. We'll help you.
00:24:55.116 --> 00:24:59.076
And, Oh, you just have to explain recessive inheritance or you just have to
00:24:59.076 --> 00:25:01.256
talk about the implications for other family members.
00:25:01.396 --> 00:25:06.876
Like, it's not that much. And it's like, oh, actually, maybe it is a lot.
00:25:07.216 --> 00:25:11.076
Yeah. Like, I know, like, in the Australian context, like, you know,
00:25:11.156 --> 00:25:16.496
one of the most common genetic conditions that we see in white populations is hemochromatosis.
00:25:16.776 --> 00:25:21.996
And really, it's not something that is seen that often in clinic.
00:25:22.216 --> 00:25:25.676
It's kind of like, oh, no, the GPs can do that. you know, we can just leave
00:25:25.676 --> 00:25:28.156
that to our primary care doctors.
00:25:28.596 --> 00:25:33.856
But I kind of think it's interesting with like in the hemochromatosis example.
00:25:34.536 --> 00:25:39.016
You know, the doctors may order, you know, a full blood count or,
00:25:39.156 --> 00:25:40.496
you know, iron levels or something.
00:25:40.676 --> 00:25:44.536
And then it's kind of like the pathologists are telling the GPs what to do.
00:25:44.956 --> 00:25:48.636
Yeah. So, it's like maybe they don't need to sort of think too much or,
00:25:48.756 --> 00:25:53.956
you know, they're really guided and having their hand held in the process of
00:25:53.956 --> 00:25:56.076
ordering a genetic test. And...
00:25:57.026 --> 00:26:00.006
To ask them to do like an extra step
00:26:00.006 --> 00:26:03.046
of actually like identifying families themselves
00:26:03.046 --> 00:26:05.846
and then to do this i don't know like is it
00:26:05.846 --> 00:26:10.726
too much and like do you think that genetic counselors like if a genetic counselor
00:26:10.726 --> 00:26:16.566
is embedded in like a practice that they will sort of just be able to do it
00:26:16.566 --> 00:26:21.126
i think there are different models and that could serve the different contexts
00:26:21.126 --> 00:26:23.146
for the different clinic types that exist.
00:26:23.426 --> 00:26:28.666
So yes, there are definitely already clinics that exist where a genetic counselor
00:26:28.666 --> 00:26:33.666
is embedded and they are doing intake family histories for new patients or they
00:26:33.666 --> 00:26:37.006
are doing the counseling around chemochromatosis.
00:26:37.446 --> 00:26:41.526
They are there to be a consultant to the clinicians when they walk past and
00:26:41.526 --> 00:26:45.306
be like, oh, hey, by the way, my patient said she had a sister with breast cancer.
00:26:45.566 --> 00:26:49.446
Is this something I need to refer for, right? So being a subject matter expert
00:26:49.446 --> 00:26:52.486
on the floor for a lot of those genetic types questions.
00:26:52.846 --> 00:26:57.406
I personally think there's plenty of work for us, but it is going to take clinics
00:26:57.406 --> 00:27:01.346
and clinicians convincing that there's more than enough work for us.
00:27:01.686 --> 00:27:08.246
So having one genetic counselor serve three or four different clinics may be
00:27:08.246 --> 00:27:13.366
also a good start in terms of we don't have to convince somebody that there's
00:27:13.366 --> 00:27:17.126
like full-time work for one genetic counselor in one clinic at all time.
00:27:17.326 --> 00:27:22.486
But that genetic counselor can serve a certain number of clinics in a city or
00:27:22.486 --> 00:27:28.686
a certain healthcare system as their expert and either virtually see their patients
00:27:28.686 --> 00:27:32.086
or go to different clinics every week type of situation.
00:27:32.306 --> 00:27:36.786
So there's lots of different ways of incorporating genetic counselors into teens.
00:27:37.046 --> 00:27:42.166
And it doesn't have to be, we have a 1.0 FTE at this clinic and this is how it's going to be.
00:27:42.326 --> 00:27:46.506
There's ways to be creative of around it. And there's a lot of genetic counselors
00:27:46.506 --> 00:27:49.386
out there who are looking for different levels of flexibility.
00:27:49.926 --> 00:27:54.106
Maybe they're not interested in full-time work. These types of roles might also,
00:27:54.206 --> 00:28:00.406
I think, serve a lot of genetic counselors who maybe aren't interested in the
00:28:00.406 --> 00:28:04.586
full clinic load that is happening at the hospital tertiary level.
00:28:04.826 --> 00:28:10.806
One of the things I love about you is your, I don't know if willingness is the
00:28:10.806 --> 00:28:16.846
right word, But, you know, your ability to work in lots of different areas of genetic counselling.
00:28:17.146 --> 00:28:21.646
So, you know, you've been in clinic and then you've been in sales and then you've
00:28:21.646 --> 00:28:24.026
been in, you know, in a lab and industry.
00:28:24.566 --> 00:28:29.106
And now you're, you know, doing this research in like this area that,
00:28:29.106 --> 00:28:31.306
you know, a lot of stuff isn't known about.
00:28:32.366 --> 00:28:38.066
In your opinion, genetic counsellors working in primary health care,
00:28:38.266 --> 00:28:43.266
do you think it's job that they can do straight out of university or do you
00:28:43.266 --> 00:28:48.186
think that a genetic counselor probably needs to have a bit more experience
00:28:48.186 --> 00:28:52.226
and then like transition into a role,
00:28:52.831 --> 00:28:57.771
lack that? Oh, no, I definitely think that a genetic counselor could jump right
00:28:57.771 --> 00:28:59.951
out of training and go into primary care.
00:29:00.311 --> 00:29:03.531
Over the years, like over the decades, if we think of the genetic counselors
00:29:03.531 --> 00:29:07.991
who graduated and then had to go to a hospital and be their hospital's first
00:29:07.991 --> 00:29:13.791
genetic counselor, you know, they created their position and what they did in their center.
00:29:14.471 --> 00:29:19.611
That takes a lot of skill, different skills than maybe we're taught in our two years master's.
00:29:19.911 --> 00:29:23.711
But if the conditioners already exist and
00:29:23.711 --> 00:29:26.611
they can just slide right in I think that's an easy an
00:29:26.611 --> 00:29:29.491
easy fit yeah I can't I don't know like I
00:29:29.491 --> 00:29:32.631
kind of was thinking the opposite like yeah I
00:29:32.631 --> 00:29:35.611
don't know you've challenged me now because I like my first job
00:29:35.611 --> 00:29:38.851
out there they hadn't had a genetic counselor for
00:29:38.851 --> 00:29:42.071
a couple of years and I was the only GC
00:29:42.071 --> 00:29:44.731
in an area and you know
00:29:44.731 --> 00:29:47.851
it was quite tough and I did
00:29:47.851 --> 00:29:50.491
have sort of the skills from my course to you know
00:29:50.491 --> 00:29:54.251
be able to do it but I kind of was thinking yeah like
00:29:54.251 --> 00:29:57.171
ideally for these kind of roles like
00:29:57.171 --> 00:30:00.131
it would be great for genetic counsellors to
00:30:00.131 --> 00:30:05.331
do like a like a two-year program like after they graduate in like a big public
00:30:05.331 --> 00:30:09.611
hospital where they get to work with more senior people and I don't know if
00:30:09.611 --> 00:30:14.451
that sort of like I think ideally that would be good but then practically it
00:30:14.451 --> 00:30:20.071
doesn't happen and yeah And maybe it's just in my head and it doesn't need to happen like that.
00:30:20.271 --> 00:30:23.851
Well, I just listened to that episode where you talked about your experience
00:30:23.851 --> 00:30:25.651
and your experience with having that mentor.
00:30:26.011 --> 00:30:31.931
And I think that that is a really valuable way of a new grad being able to take
00:30:31.931 --> 00:30:36.711
up a new position, but still have that mentorship and experience from somebody
00:30:36.711 --> 00:30:38.971
else to help guide them through it.
00:30:39.711 --> 00:30:41.451
Genetic counselors aren't like,
00:30:42.091 --> 00:30:47.171
It could be a 22-year-old new grad or 24-year-old that's their first job,
00:30:47.211 --> 00:30:52.131
but a lot of Janiac counselors are graduating in their 30s and 40s after having
00:30:52.131 --> 00:30:54.351
gained different work skills.
00:30:54.531 --> 00:30:59.071
And so for them, it's not necessarily a difficult challenge,
00:30:59.071 --> 00:31:00.651
or it would be difficult,
00:31:00.851 --> 00:31:05.151
but it wouldn't necessarily be insurmountable to use their skills that they'd
00:31:05.151 --> 00:31:11.011
had at previous jobs to go into primary care and create that space.
00:31:11.011 --> 00:31:17.751
Now, one of the things that you said to me was that after a few years in one
00:31:17.751 --> 00:31:23.271
particular job or one type of job, you sort of felt like you hit a wall and
00:31:23.271 --> 00:31:25.091
then you sort of have pivoted.
00:31:25.091 --> 00:31:28.271
And I was just wondering if you could tell me about that.
00:31:28.431 --> 00:31:34.071
Like, when it happened for the first time, were you sort of working clinically
00:31:34.071 --> 00:31:36.411
and then you were like, okay, what else is there?
00:31:36.751 --> 00:31:41.091
Or, yeah, did you sort of get itchy feet or what happened there?
00:31:41.491 --> 00:31:45.671
I am an impatient person when it comes to inefficiencies.
00:31:47.151 --> 00:31:51.211
And healthcare is not a great place. They don't move super fast when there's
00:31:51.211 --> 00:31:53.911
something inefficient, right? Like we can look, I can look at the problem.
00:31:54.031 --> 00:31:57.291
I'm like, if we did this, this, and this, you know, it would fix this.
00:31:57.531 --> 00:32:00.431
But then we got to go through the manager and they're going through the director.
00:32:00.651 --> 00:32:03.931
Oh, and everything just takes so long.
00:32:04.751 --> 00:32:09.071
And you eventually either hit a wall of funding or you hit a wall of people
00:32:09.071 --> 00:32:14.571
who don't see the value in what we're trying to do to solve a certain problem.
00:32:14.571 --> 00:32:21.651
And so, yes, I hit walls, I would say, about three years in terms of seeing
00:32:21.651 --> 00:32:27.191
how things could be different and how things could be improved and not necessarily
00:32:27.191 --> 00:32:29.271
having the support to do that.
00:32:29.491 --> 00:32:34.971
So this impatience has allowed me to pivot a lot of times in my career.
00:32:35.231 --> 00:32:37.711
So the first time I...
00:32:38.932 --> 00:32:47.992
Pivoted out from clinical to industry was, I would say, I hadn't hit my wall
00:32:47.992 --> 00:32:51.592
fully, but for personal reasons, we were leaving and moving back to my hometown.
00:32:51.872 --> 00:32:56.732
And so it felt like a good time to try something new in terms of directions.
00:32:56.732 --> 00:33:01.272
And that's when I went into sales, which is how I met you because the company
00:33:01.272 --> 00:33:05.252
where I worked for at the time felt like, Oh, of course she could cover all
00:33:05.252 --> 00:33:07.312
of Canada and all of Australasia.
00:33:07.752 --> 00:33:11.352
And so I took up the challenge and I enjoyed that.
00:33:11.532 --> 00:33:16.132
But then again, hit the same kind of wall, even in that sales role.
00:33:16.392 --> 00:33:20.612
Did a little pivot in internally to a lab role.
00:33:20.612 --> 00:33:23.852
And then with that
00:33:23.852 --> 00:33:27.032
experience my province created a new
00:33:27.032 --> 00:33:30.052
like the first laboratory genetic counselor
00:33:30.052 --> 00:33:39.052
role for our province where I was hired to kind of help create the genetic resource
00:33:39.052 --> 00:33:43.812
center which allowed non-genetic physicians to more easily access genetic testing
00:33:43.812 --> 00:33:48.332
for their patients so So they would request a genetic test, and I,
00:33:48.472 --> 00:33:49.552
as the lab genetic counselor.
00:33:50.112 --> 00:33:52.572
Would pick out the appropriate test.
00:33:53.092 --> 00:33:56.652
And then when the results came back, I could communicate with the clinician
00:33:56.652 --> 00:34:01.372
saying, hey, by the way, it's in the U.S., and here's what you might want to do with that.
00:34:01.472 --> 00:34:07.212
Or, oh, it's positive you may want to make these referrals after you disclose the results.
00:34:07.212 --> 00:34:17.172
So I've done a lot of pivoting in my career, but I think each pivot has led me closer to,
00:34:17.372 --> 00:34:22.792
I think, what my ultimate goal has always been, which is how to improve access
00:34:22.792 --> 00:34:25.472
to genetic testing and genetic services to patients.
00:34:25.872 --> 00:34:28.952
So the roles in terms of.
00:34:29.453 --> 00:34:34.653
Improving non-geneticist clinicians being able to order genetic testing in my province,
00:34:35.133 --> 00:34:38.873
knowing that more patients were getting more timely access to genetic testing,
00:34:39.053 --> 00:34:41.753
and then thinking, well, it's great that they're getting this faster access
00:34:41.753 --> 00:34:44.513
to testing, but they're not getting faster access to genetic counseling,
00:34:44.753 --> 00:34:49.273
which is what made me pivot to the integration into primary care.
00:34:49.433 --> 00:34:55.073
So it's just, how do we get genetic services to patients more quickly?
00:34:55.073 --> 00:34:59.833
I can imagine as someone that appreciates efficiency,
00:34:59.833 --> 00:35:07.753
getting a job as a lab GC where it's all about trying to be efficient and not
00:35:07.753 --> 00:35:10.213
wasting resources and, you know,
00:35:10.273 --> 00:35:14.393
not doing a genetic test twice because it only needs to be done once.
00:35:14.513 --> 00:35:17.473
I don't know, that was probably like really exciting.
00:35:17.713 --> 00:35:22.153
Like, did it sort of like recharge the batteries that you were able to make
00:35:22.153 --> 00:35:23.713
these sort of efficiencies?
00:35:24.293 --> 00:35:27.393
I made the best spreadsheets in that job, right?
00:35:28.613 --> 00:35:35.073
I took the opportunity to really collect as much data as I could in that context
00:35:35.073 --> 00:35:38.513
so that, yeah, we weren't duplicating tests.
00:35:38.773 --> 00:35:43.833
We could see historical ordering patterns and then how we could make improvements
00:35:43.833 --> 00:35:46.853
in terms of we're ordering this volume, things like that, and so,
00:35:47.053 --> 00:35:48.613
you know, get better deals.
00:35:48.613 --> 00:35:54.853
But what I had wanted to do in that context also is, as one of the problems
00:35:54.853 --> 00:35:59.693
I found before were variants of uncertain significance, right?
00:35:59.973 --> 00:36:02.093
So you would find this answer. You don't know what it means.
00:36:02.093 --> 00:36:04.893
Is it nothing? Is it benign? Or is it pathogenic?
00:36:05.333 --> 00:36:11.413
And before there was one place tracking all the results, every clinician just
00:36:11.413 --> 00:36:14.413
had to track their own VUSs, and most didn't.
00:36:14.413 --> 00:36:19.173
And so typically there would be that paragraph in the end of every genetics
00:36:19.173 --> 00:36:23.833
letter with a VUS to patients reach out to us in five years and we'll see if
00:36:23.833 --> 00:36:25.133
this information has changed.
00:36:25.582 --> 00:36:30.462
But being in that role as the lab GC, I could track all the VUSs.
00:36:30.642 --> 00:36:36.042
And so I was keeping track of all the VUSs. And I did this project where annually
00:36:36.042 --> 00:36:43.142
I would reach out to the labs and say, hey, you tell me if there are changes to the interpretation.
00:36:44.502 --> 00:36:51.042
And surprisingly, there often was. There were some labs who would err on the
00:36:51.042 --> 00:36:54.262
side of being conservative and call them VUSs, Whereas a year later,
00:36:54.442 --> 00:36:56.202
they were like, no, we'll downgrade this to benign.
00:36:56.682 --> 00:37:00.902
And there were others where, oh, yeah, this has since been seen in another family.
00:37:01.042 --> 00:37:03.902
This is pathogenic. We will reissue you the report.
00:37:04.482 --> 00:37:08.062
And so this allowed, for me, what I felt,
00:37:08.182 --> 00:37:11.742
a much more equitable approach to VUS interpretation
00:37:11.742 --> 00:37:17.062
because I never felt it was equitable to put that all on the patient's plate
00:37:17.062 --> 00:37:22.002
because then you're really going to have only the most educated and the most
00:37:22.002 --> 00:37:27.002
well-informed patients calling back for their VUSs when that is not necessarily
00:37:27.002 --> 00:37:28.982
representative of our population.
00:37:29.302 --> 00:37:35.222
And so this felt like I was giving everyone in the province who had a VUS an
00:37:35.222 --> 00:37:37.422
equal chance of having that reinterpreted.
00:37:37.982 --> 00:37:39.522
That is so cool.
00:37:40.902 --> 00:37:47.522
In your role, like when you're kicking goals and you're getting stuff done and
00:37:47.522 --> 00:37:51.242
getting the U.S. is reclassified and that sort of thing.
00:37:51.382 --> 00:37:57.622
Were you also able to show, like from a business case sort of point of view,
00:37:57.802 --> 00:37:58.942
that you were saving money?
00:37:59.642 --> 00:38:06.102
Yes and no, right? We were able to show how we change testing protocols for
00:38:06.102 --> 00:38:11.102
a specific testing order to be more economical.
00:38:11.102 --> 00:38:16.102
But also keeping in mind that once the lab genetic counselor and the Genetic
00:38:16.102 --> 00:38:20.982
Resource Center was available, the floodgates opened up and we had a significant
00:38:20.982 --> 00:38:22.722
increase in the number of orders.
00:38:23.002 --> 00:38:27.462
So in terms of budget, the amount of money that we spent significantly increased
00:38:27.462 --> 00:38:31.462
because more people were getting timely access and appropriate access to the
00:38:31.462 --> 00:38:35.002
genetic testing that they had to wait for before.
00:38:35.342 --> 00:38:40.062
And so what I tried to show, not just in terms of cost savings,
00:38:40.102 --> 00:38:44.782
is that when you had the pediatric nephrologist order the test,
00:38:44.782 --> 00:38:48.102
rather than that patient sitting on the wait list for years,
00:38:48.742 --> 00:38:52.682
seeing the geneticist or a genetic counselor, then testing being done,
00:38:52.822 --> 00:38:55.702
and then having a result session again.
00:38:56.739 --> 00:39:01.759
They were being tested at their point of care and only the positives and sometimes
00:39:01.759 --> 00:39:04.799
the VUSs, depending on the context, were seen in genetics.
00:39:05.079 --> 00:39:10.099
And so we were able to see more patients in genetics because we weren't doing
00:39:10.099 --> 00:39:13.939
the two appointments for each patient and the testing had been done up front.
00:39:14.119 --> 00:39:19.899
So it allowed us to not have as many patients just be stagnant on our wait list
00:39:19.899 --> 00:39:21.439
because the testing had been done.
00:39:21.639 --> 00:39:25.299
It was negative. There's nothing more that genetics could offer at that time.
00:39:25.299 --> 00:39:32.219
And so it just helped to declog some of the genetics waitlist once we were able
00:39:32.219 --> 00:39:36.839
to incorporate genetic testing care across other departments.
00:39:38.159 --> 00:39:44.959
So when we met in person, I remember you were my contact person because I had
00:39:44.959 --> 00:39:49.839
a private practice in Australia and I was ordering tests through the lab that you worked at.
00:39:49.839 --> 00:39:56.259
And, you know, I was really happy that I had my own personal contact person,
00:39:56.259 --> 00:39:59.419
even though you're on the other side of the world and in a different time zone.
00:39:59.459 --> 00:40:04.019
But then you sort of said, oh, and by the way, I'm moving with my family to
00:40:04.019 --> 00:40:06.379
Australia for several months.
00:40:06.639 --> 00:40:11.779
And yeah, I'll continue to be your contact person. I was like,
00:40:11.879 --> 00:40:15.679
oh my gosh, like, sorry, when I was,
00:40:16.157 --> 00:40:24.717
a student, there was no like way that we would ever like fathom working for a lab that,
00:40:25.017 --> 00:40:28.277
you know, you could be a genetic counselor that you could move with your family
00:40:28.277 --> 00:40:31.697
to the other side of the world. It was like, that is so cool.
00:40:31.937 --> 00:40:36.417
But in talking to you about it, it wasn't kind of just offered to you.
00:40:36.497 --> 00:40:41.077
I think that you sort of had to make a case and sort of show the benefits.
00:40:41.357 --> 00:40:48.117
And, And, you know, was that a difficult thing to do or, you know,
00:40:48.217 --> 00:40:51.097
were you able to just chip away at it and then your bosses said,
00:40:51.217 --> 00:40:52.957
yeah, sure, like I would make it happen?
00:40:53.837 --> 00:40:56.897
Well, it was kind of their fault because if they're going to give me all of
00:40:56.897 --> 00:41:01.357
Canada and all of Australasia, like I'm going to take advantage of this.
00:41:01.497 --> 00:41:07.137
I'm somebody who likes to travel and always wanted that to be a part of my life and my kid's life.
00:41:07.737 --> 00:41:11.437
And I had backpacked in Australia when I was 20. So I was one of those annoying
00:41:11.437 --> 00:41:16.677
tourist backpackers on those bus tours that you see up and down the coast back in the day.
00:41:16.897 --> 00:41:22.417
And so when the opportunity came, I had gone to the HGSA meetings a few times
00:41:22.417 --> 00:41:25.697
and that was a great touch point, but not enough.
00:41:25.857 --> 00:41:30.617
And one of my favorite parts of working in sales was actually just talking to
00:41:30.617 --> 00:41:33.137
the genetic counselors and geneticists, right?
00:41:33.137 --> 00:41:39.077
By the hearing the difficulties they were having in their clinics,
00:41:39.617 --> 00:41:45.457
seeing how similar all clinics are across the world and what different things we could do to help.
00:41:45.637 --> 00:41:51.917
But I didn't just want to go for one week trips at a time. It is a long flight from Canada.
00:41:52.137 --> 00:41:54.457
And so my kids were six and three.
00:41:54.717 --> 00:41:58.337
So they were still young enough that we could pull the six-year-old out of grade
00:41:58.337 --> 00:42:01.417
one. My husband works remotely, so he could work.
00:42:01.934 --> 00:42:05.634
From Australia. And so it just kind of was a good fit.
00:42:05.754 --> 00:42:11.474
So I was able to write a business plan to why they should allow me to go to
00:42:11.474 --> 00:42:18.074
Australia and New Zealand for three months, take my husband and kids and do like a full blast.
00:42:18.174 --> 00:42:23.874
I think I did at least 50 different clinic visits to a variety of different
00:42:23.874 --> 00:42:27.094
businesses in Australia and New Zealand and met so many great people.
00:42:27.854 --> 00:42:31.174
And they agreed. They turned like if they were really going to take trying to
00:42:31.174 --> 00:42:34.654
break into the Australian market seriously, this is how it was going to have to be done.
00:42:34.974 --> 00:42:38.594
But like, this is where using previous life skills come in common.
00:42:38.794 --> 00:42:45.374
I was a waitress. I could sell you, I could upsell you, like adding ribs to that stake, right?
00:42:45.474 --> 00:42:49.414
Like you just, part of being in sales, if I couldn't sell them on this idea,
00:42:49.554 --> 00:42:51.614
then I shouldn't have been selling their genetic tests, right?
00:42:51.754 --> 00:42:54.774
So I think it was such a great experience.
00:42:54.774 --> 00:42:58.694
And then we went and then some of my parents came because somebody had to watch
00:42:58.694 --> 00:43:02.294
the kids while my husband and I were working and then not to be undone,
00:43:02.814 --> 00:43:04.214
his parents also joined.
00:43:04.214 --> 00:43:08.754
So we were a crew of eight going across Australia and New Zealand for the three
00:43:08.754 --> 00:43:10.534
months and it was such a great time.
00:43:10.934 --> 00:43:16.354
Oh, that's funny because I knew that there was parental involvement but I thought
00:43:16.354 --> 00:43:20.774
that there was only one parent but it sounds like there were four parents there.
00:43:21.034 --> 00:43:23.934
It was a caravan. It was a whole thing.
00:43:26.194 --> 00:43:33.254
That's lovely. And I love that I was able to do something really Australian with you.
00:43:33.534 --> 00:43:37.894
And we walked from, what was it? We did the walk from Bronte to Bondi.
00:43:38.634 --> 00:43:44.294
Yes. I love Australia so much. And I love the HGSA conference.
00:43:44.514 --> 00:43:47.354
And it is just so disappointing to me that it's
00:43:47.354 --> 00:43:50.394
in August because August is one of the few months where
00:43:50.394 --> 00:43:53.314
it's like 30 degrees every day in our in
00:43:53.314 --> 00:43:56.454
our province I don't want to abandon ship
00:43:56.454 --> 00:44:01.074
like during the best month of the year to go across the world so if you guys
00:44:01.074 --> 00:44:06.614
move the conference to March February March that would be ideal because what
00:44:06.614 --> 00:44:14.954
is February or March like for you weather-wise oh February you're looking at minus 30. yeah,
00:44:16.077 --> 00:44:18.697
That doesn't sound pleasant. I'm not going to lie.
00:44:20.857 --> 00:44:27.717
So, in being a podcast host and talking to genetic counsellors,
00:44:27.977 --> 00:44:35.017
one of the things that I've started to notice is a lot of the GCs saying how
00:44:35.017 --> 00:44:40.017
important it is to volunteer in the genetic counselling community.
00:44:40.017 --> 00:44:44.077
And it's something that you sort of mentioned as well.
00:44:44.077 --> 00:44:50.737
And I think, forgive me for not knowing, but did you just finish being chairperson
00:44:50.737 --> 00:44:55.497
of your, like of the Canadian Society of Genetic Counselors or?
00:44:55.797 --> 00:44:59.477
I'm in the last couple months of the, being the chair of the Canadian Board
00:44:59.477 --> 00:45:03.557
of Genetic Counseling. So our credentialing certification organization.
00:45:04.697 --> 00:45:10.897
And pre-COVID, I was on the Board of Directors of the Canadian Association of
00:45:10.897 --> 00:45:16.817
Genetic Counselors. So I've done my time in the two larger organizations in Canada.
00:45:17.017 --> 00:45:20.537
And how important is it to be involved?
00:45:20.937 --> 00:45:26.217
I can't overstate how important I find volunteering in our professional organizations.
00:45:26.797 --> 00:45:33.397
And it doesn't, that's going to be at a high level where you're giving multiple
00:45:33.397 --> 00:45:35.097
hours a week to an organization.
00:45:35.097 --> 00:45:42.017
But I don't want for people to think that these organizations are just,
00:45:42.543 --> 00:45:47.423
We'll just continue running without the participation of the genetic counselors
00:45:47.423 --> 00:45:51.723
in the area providing volunteer support.
00:45:51.983 --> 00:45:58.663
And it can be as small as... Like helping me to organize a conference or...
00:45:58.663 --> 00:46:04.183
Organizing a conference or helping with a newsletter, right?
00:46:04.243 --> 00:46:05.323
A quarterly newsletter.
00:46:05.623 --> 00:46:12.163
And just being involved the way that I have met both new friends and new colleagues,
00:46:12.163 --> 00:46:15.663
have been able to provide references for new genetic counselors.
00:46:16.003 --> 00:46:21.323
Having served with them on different committees, just understanding the full
00:46:21.323 --> 00:46:25.743
landscape of the genetic counseling profession across Canada by meeting all
00:46:25.743 --> 00:46:32.563
these individuals has really only added value to my personal life and to my career.
00:46:32.903 --> 00:46:36.223
As somebody who has, who's now mid-career, right?
00:46:36.323 --> 00:46:43.323
Like I'm, I'm an elder millennial, and my perspective may not speak to the needs
00:46:43.323 --> 00:46:49.103
of younger millennials and the Gen Zs who are coming into the profession now.
00:46:49.103 --> 00:46:56.243
And so you don't want all of your volunteer organizations only having those
00:46:56.243 --> 00:47:01.203
mid and late career genetic counselors because we may not be building the profession
00:47:01.203 --> 00:47:06.723
the way that it needs to be for the early career genetic counselors.
00:47:06.723 --> 00:47:12.083
And so having those get involved even just a little bit early on in their careers,
00:47:12.323 --> 00:47:17.023
even when you're exhausted from training and you're exhausted from potentially
00:47:17.023 --> 00:47:22.843
studying for boards or getting your certification, going through all the long
00:47:22.843 --> 00:47:24.543
case processes that you have to do.
00:47:25.283 --> 00:47:29.623
Finding just even a little bit of time to do that, to be involved in the profession
00:47:29.623 --> 00:47:33.563
so that your voice and your perspective is heard, I think is very important.
00:47:33.563 --> 00:47:37.063
Yeah oh well I
00:47:37.063 --> 00:47:43.083
think on that note thank you so much for joining me on the podcast today thank
00:47:43.083 --> 00:47:47.583
you for having me I really enjoyed catching up and and having a good chat with
00:47:47.583 --> 00:47:53.243
you you too thanks for listening as always a big thank you to my editor Nick
00:47:53.243 --> 00:47:54.863
have a great rest of your day.