Aug. 25, 2025
146: Your Veterinary Sixth Sense: How It Works, And How to Teach It. With Dr Annie Wayne
Ever had a case where you just knew what was wrong before you even touched the patient - but if someone asked you HOW you know, you couldn’t explain it?
That almost mystical “sixth sense” we develop in practice - that’s exactly what this episode is about.
Our guest is Dr Annie Wayne - a criticalist, educator, and learning strategist—who’s been exploring naturalistic decision making: the cognitive model that explains how experts think in real-time, and how to pass that intuition on.
We talk about what separates expert intuition from novice reasoning, how to break down unconscious diagnostic processes, and how the right kind of mentorship can accelerate the path to expertise. Annie also shares her research on parenting and vet careers, challenging the stigma around pregnancy and parenthood during training.
Here’s what you’ll learn:
- What “naturalistic decision making” really means (and why it feels like a sixth sense)
- How experienced vets spot subtle signs that others miss
- How to externalise your gut feeling so younger vets can learn from it
- Real-world strategies for mentorship and better clinical teaching
- How to avoid the traps of lazy “shortcut” thinking
- How this framework builds confidence and reduces stress in new grads
- Annie’s personal take on parenting through training—and how to smash the stigma around pregnancy in vet careers
This isn’t just about clinical decision-making - it’s about how we teach, how we lead, and how we support each other in a demanding profession.
Lift your clinical game with our RACE approved clinical podcasts at vvn.supercast.com for more clinical confidence and better patient outcomes, or check out our Advanced Surgery Podcast at cutabove.supercast.com.
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Topics and Time Stamps
04:53 What is Naturalistic Decision-Making?
08:36 Expert vs Novice Thinking: Why Mentorship Matters
15:55 Risks of Shortcut Thinking and Balancing with Algorithms
19:11 Speeding Up Expertise: Can We Teach "Sixth Sense" Thinking?
22:47 Mentorship Models: Building Skills and Confidence
34:45 Can AI Help Naturalistic Thinking?
37:20 Parenthood and Veterinary Careers: Breaking Stigma and Building Support
What Is Naturalistic Decision-Making in Veterinary Medicine?
In veterinary medicine, Naturalistic Decision-Making (NDM) refers to the "sixth sense" or "vet version of a spidey sense" that experienced veterinarians develop, allowing them to "just know" what is wrong with a patient without being able to fully explain how they arrived at that conclusion. This form of expert-level thinking becomes automatic over years of experience.
Key aspects of Naturalistic Decision-Making include:
- Subconscious and Intuitive Thinking: NDM involves subconscious decision-making or thinking that one is not necessarily cognitively aware of. It is how experts know what they know, even if they cannot articulate the process.
- Real-World Application: This science, which emerged in the 1980s with Gary Klein as a pioneer, focuses on how people make decisions in high-pressure, uncertain, and emotionally dynamic real-world environments.
- Beyond Algorithms: NDM contrasts with traditional algorithmic diagnostics, which follow flow diagrams and sequential steps. Instead, NDM allows experts to seemingly "skip from step one to the last step magically".
- Core Components:Tacit Knowledge: This is intuitive, built-in knowledge derived from extensive experience. For example, an experienced vet might instantly recognise an aortic thrombus in a cat by a "very specific sound" because that sound has become ingrained in their brain through repeated exposure, even if they cannot consciously access how they know it.
- Seeing the Invisible: This involves noticing subtle cues, such as an animal's body language, that indicate its condition, which might not even be verbalisable. For instance, a nurse with a decade of experience could identify tick paralysis in an ataxic patient simply by looking at them, a skill that took another vet five years and hundreds of cases to approach.
The ability to develop NDM is learnable and teachable, and understanding it is crucial for accelerating the development of mastery and confidence in new graduates. By learning how experts think, new clinicians can transition from knowing many facts to effectively integrating them into clinical patterns and critical thinking, rather than just relying on lists of differentials. It is also seen as a way to normalise the time required for expertise development, reducing the stress new graduates feel when they struggle with cases, as it acknowledges that expert thinking takes time to develop.
5 Ways to Help New Grads Develop “Veterinary Spidey Sense”
To help new graduates develop their "veterinary spidey sense," which is synonymous with naturalistic decision-making (NDM)—the ability for experts to "just know" what's wrong with a patient without being able to fully explain how—the sources suggest several strategies:
- Implement Structured Mentorship Programmes and Explicit NDM Training Organisations like Ethos are developing mentorship programmes where both mentors and trainees are trained on what naturalistic decision-making is and how experts think. This involves creating a toolkit, providing resources, and fostering a culture of mentorship. A social scientist, Brian Moon, has partnered to help understand this science and develop training materials, including a game, to help people grasp NDM concepts and learn to ask the right questions. The aim is to accelerate the process of developing mastery and confidence, which traditionally takes years.
- Encourage Mentors to Externalise Their Internal Thought Processes A key method involves experienced vets verbalising the subconscious decisions and subtle cues they pick up on. For instance, an expert might instantly recognise an aortic thrombus in a cat by a specific sound, even if they can't immediately explain why. Mentors can articulate these "invisible" observations, such as body language cues that indicate a dog's condition, to make their intuitive thought processes accessible to trainees. This helps bridge the gap between an expert's automatic thinking and a novice's need for structured understanding.
- Utilise Targeted NDM Questions to Uncover Intuitive Thinking Experts in NDM have developed specific questions designed to unlock this type of thinking, both for mentors to explain their process and for trainees to develop it. Examples of these questions include: "What information did you ignore?", "What subtle cues did you pick up on?", "What did you notice that maybe I didn't notice?", "What are you tracking in the bigger picture?", and using a "pre-mortem" (imagining the worst-case scenario and how to avoid it). These questions help individuals break down complex situations and consider factors beyond algorithmic diagnostics.
- Normalise the Time Required for Expertise Development and Reduce Stress It is crucial to normalise the fact that expert-level thinking takes time and is not expected immediately upon graduation. By acknowledging that new graduates are "good learners" but not yet "experts," the stress associated with struggling with cases can be reduced. This approach helps new clinicians understand that difficulties are a natural part of their brain developing shortcuts, rather than a reflection of their competence or worth.
- Provide Access to Expert Insights through Diverse Learning Avenues Learning can be accelerated by leveraging various sources of expert knowledge. Clinical podcasts are highlighted as a way to "pick the brains of experts" who have seen hundreds of cases, sharing insights not typically found in textbooks and helping new grads make crucial connections. Additionally, interns training students and residents training interns are often described as the "best teachers" because they are closer to the novice perspective and can remember how to think like one, making their insights particularly valuable.
Have you ever been in a situation as an experienced vet where a less experienced colleague asks you for help with a work up and you instantly know the answer?Like bam I know what's wrong with this patient.Then your colleague does the test, they scan it or they run bloods or whatever and it turns out that you were right.
0:20
So they ask you, how did you know that?And when you try to explain it, you can't.You don't actually know how you knew, you just knew.Kind of like a sixth sense.I'm Ebert Emstrat and you're listening to The Vet Vault, where we dig into your secret superpowers that make vet life not just doable, but deeply satisfying.0:41
I've experienced this in reverse many times, most recently when I first started working in Queensland about five years ago.For the first time in my career, I had to deal with Dick paralysis cases, a disease that is so devastating that a misdiagnosis or a wrong decision can be, and often is fatal.0:58
So when I.Started here, I'd admit.An ataxic patient for a nearer's work up or book lung grads for a cat with breathing issues.A totally correct approach by the way, when we're thinking of algorithmic diagnostics.But then a nurse who'd been working in the area for a decade would take one look at my patient and go, yeah, that dog is a Dick.1:17
And of course they'd be right.And I couldn't understand how they picked it so quickly.Now I do, but it took me 5 years and hundreds of tick paralysis patients to get anywhere near that level of smarts.Actually, I'm still not quite there.There's a name for that skill, that knowing without how you know.1:34
It's called naturalistic decision making.And while it is really like a sick sense, there's nothing magical or supernatural about it.It's learnable and it's teachable.Dr. Any Wayne, a criticalist educator and a self confessed learning nerd, has been studying the science of how we know the stuff.1:50
We just know how we develop that vet version of a Spidey sense.Why?Because if we understand it better, then maybe we can teach it better and we can accelerate that process so it doesn't have to take somebody years to develop mastery and get the confidence that comes with that mastery.2:07
And who couldn't do with a little bit of extra confidence after this plug for our upcoming conferences, how we develop and how to teach your veterinary 6th sense.So I've been going on about Vets on Tour, the company that I've partnered with that organizes conferences in amazing locations.2:23
Actually, not conferences.Conferences can be boring, and Vets on Tour events are definitely not boring.Let's call them educational adventures.By the time this episode goes live, we'll either be in New Zealand or just about coming back.And then we are all systems go with final planning for Nozawa Ansen in Japan in February next year.2:43
Our topics for Nozawa are surgery, emergency and imaging.But if skiing powdery gullies and Hot Springs and authentic Japanese mountain village life is not your thing, then maybe tropical island life is.The cat is now officially out the bag.We are heading to the Maldives in April 2020.3:00
Sixth.So surfing, there's a wave at the front of the conference venue, diving and fishing, or just cocktails in the pool if you are feeling less energetic.Spots for this one are very limited and this is not just the marketing trick.We have space for about 25 people only, so really don't stuff around if you think you'd like to come.3:19
Details for all of these events are at Vets on tour.com.I'd love to see you there.OK, let's get into naturalistic decision making with Doctor anyway.I want to start this and I wonder if it's going to be off the mark or not, but I want to start with the story of something that happened to me clinically one day and I want to check if that is that falls in the basket of the topic we want to discuss today.3:50
So many, many years ago, I was probably about 10 years qualified.I was working in the UK and the clinic was set up, the work areas at the bottom and then we had our office on the 2nd floor and you can sort of hear what was happening in reception from the office area.We were us, myself and a bunch of the other vets were sitting there having lunch and door opened and we could hear this cat making up an almighty noise.4:13
Obviously an emergency consult, the walk in, they're like, who's who's going to take this one?And one of the younger colleagues said, I was OK, I'll do it and you guys have lunch.And as you walked out the door, I went, it's got an aortic thrombus, by the way.And he was like, he stopped.He was like, what?I said, that cat, it's got a thrombus.4:29
And he's like, whatever.He did the consult and he came back 15 minutes later.He was like, how the fuck did you know that?It's a very specific sound, yes.And I, he said, how did you know that?And I said, I don't really know.4:44
It's just a sound.He was like, what sound?I said, I don't know.It's just what that's what they sound like.What was I doing there, Eddie?Yes, you are spot on.That is the science of naturalistic decision making, which is how experts know what they know.5:00
So how did you know?You just knew, and it's really not just the science about experts know what they know, but why is it that you can't even explain to somebody how you know that?So how do those things become automatic for experts?And how do you then break that down so you can help people who are not experts understand how experts think and how to develop that type of thinking instead of just learning the facts, learning how to think like an expert.5:33
But you're spot on.That is exactly what we're talking about.The naturalistic decision making, I've always because there's a, there's a couple of scenarios where I realize I'm doing it and it comes with experience, obviously, but we're on the emergency floor within seconds of an animal coming in.5:50
I've got a fairly good idea.Am I going to admit you or are you going to be in and out patient?I don't know.It's a body language thing.The dog just shows me that it's not.I'm not so good at cats with that.Cats are better at hiding it, yeah.Yeah, exactly.But but it feels almost like a sixth sense.6:07
I'm familiar with the term heuristics.Is it a, is it?Yeah.Does that tie into all of that?It's like subconscious subconscious decision making or thinking that you're not necessarily cognitively aware of is that.Exactly, exactly.So just to define it, it's really how people make decisions in the real world in high pressure on certain environments.6:27
So this science is fairly new.It really just emerged in the 1980s.Gary Klein is sort of the the father of this science and I came across a book by him a long time ago and this idea rattled around in my brain for a really long time.6:44
But when I read about it, I was like, this is exactly what happens in the ER, right?Like it's a high pressure, emotionally dynamic thing where when you're expert at it, you do you make these decisions really quickly.You have to figure out what's happening really quickly and then constantly be changing that based on what additional information you get.7:04
And when you're learning to do that, it feels like the experts just know it.Like how do they know things like that?How do they make these decisions so quickly?And it feels really mysterious, I think to both the experts and the novices.And so when I read about this idea, I, I really, I thought it just explained it so perfectly.7:26
And but I couldn't figure out how to then bring it into the work that I was actually doing in the clinics.And then when I joined Ethos, I joined at a time where we were starting a, a mentorship program at Mass Vet, which is one of their big hospitals.7:44
And I had a, a partner who was helping me start a mentorship program there.And she was really game to kind of do things differently.And when I told her about this idea, she got really excited about it.So the two of us then were in this figuring out like how do we take this concept that is a totally different science and bring it into the mentorship program that we're doing.8:08
So that's been a lot of what we've been thinking about and figuring out over the last couple of years.OK.So your interest in this is you're trying to take that magic and make it available to NEO grads because as I said before, these sort of things that I noticed over my career, that's five years in, 10 years in into the same job that you start noticing the magic is starting to happen behind the scenes and you're trying to expedite that process.8:35
Is that right?Yeah, I think it's the way I think about it now is naturalistic decision making is good for mentors and trainees.So if we can sort of uncover how the experts are thinking for both sort of teams, then they can have different kinds of conversations on the clinic floor as mentorship is happening.8:55
And so really one kind of training both our mentors and our trainees on what is naturalist decision making, How do experts think?But really the, the things we've figured out are telling both people like this is a thing that is real, you know, the 6th sense.9:12
It's it's really expert level thinking that becomes automatic.And it's also why traditionally it's always been the best teachers are the ones who have just gone through it because they're not all the way to the expert thinking where it's so automatic.It's like the interns training the students, the residents training the interns.9:30
Those are often the best teachers because they're close enough to it to remember how the novice thinks about it.And the expert is so far they can't even remember how to think like that.So they can't break down like.Yeah, I I totally find it because I interview specialists all the time and it's often noticeable that they surprised at what I don't know or at deep level we don't know.9:54
And so you you forget what you didn't know.But we do it as vets as well with our clients, right?You, you speak to clients about stuff and you explain it and then you think, oh, they're so stupid, they don't get it.Then we go.Yeah, you forgot that.The day before you started studying vet science, you that do nothing.10:09
This is mysterious to you.So yeah, you do forget what you don't know.I love that you think about this in your job in trying to train and mentor because we so you know, it's it's not the way we do it.We teach algorithmically.If I'm going to teach somebody decision making, the classic teaching is the flow diagram.10:27
If there's yes, no, then that, then that.And what we try to do is to skip from step one to the last step, magically just skipping all the all the in betweens.Why?Why does this matter to you?Why do you think it's important for people to get this kind of thinking?10:43
I mean, I, when I finished my residency back into academia, which I really wasn't planning on it, and it all worked out.And then I found this whole world of like, you're thrown into teaching, right?Like you're a vet and you are a specialist, so you should know how to teach that.And you sort of have to figure it out as you go.11:00
And when I came across this, to me, this was like a really helpful framework to think about it.And the more I talk to people about it, the more people it really makes sense to them.Like the whole story that you just shared about that cat with the Thrombus, Like everyone kind of clicks with that type of story of yeah, you just know.11:21
And so the more I talk to people about it, the more I think people get excited about it to understand, how do you know that when you're an expert?And then how do you translate that?Just teaching the facts is fine.But I think my whole job now is to think about how do we take new graduates who know a lot of facts and don't know anything clinically.11:42
Like they don't know how to integrate their facts into a clinical pattern.They don't know how to reverse think when they see a patient come in the door to then figure out how to get to the differential.They know like this Signalman goes with this list of differentials, they don't know how to reorder it.How do we help them get from all of the facts that they know to being really solid, good ER clinicians in a relatively short amount of time?12:07
And to me, this is like a really big unlock for, again, for the trainees to understand and then also for the experts who are training them on the floor to understand.But I think if we can just shift the conversation slightly and have people ask slightly different questions, then they can, like you say, instead of just getting the algorithm, they can start to develop those expert level thinking faster.12:33
So they're learning how to think, how to think critically, as opposed to learning the list of differentials or the fact patterns.And, and the reason why this is important, obviously productivity, you could get through shit faster if you don't have to spend an hour with a textbook going through all the DDS.12:53
But is, is it also a stress thing?Because it's stressful when you are, let's say it's a big stress relief.If it takes me a split second to at least know which direction I should start looking at versus that and was unwell, I don't even know where to begin.13:11
Yeah, I think it's stress in that way, but I think it's also stress and understanding that you're at the at the point when you graduate from that school.There's not an expectation, there shouldn't be that you should be thinking like an expert, right?Like that takes time to develop and there's a whole science figuring out how it develops.13:30
So to me, it takes the stress level down to be like, the expectation is that you are a really good learner and you are really good at, you know, learning how to be an expert, but the expectation is not that you're an expert.So I think it normalizes that you're a new graduate and you're at a certain level and there is a big gap in terms of how you think to an expert.13:55
So to me, it's not the stress of like, do you know what to do next?I think that's important, but I think it's also more important to normalize.Like expert level thinking takes time to develop, and we know that there are specific things that can help get there too.Gotcha.So when I struggle with the case when you're out, instead of saying, oh, I'm so stupid, you're not stupid.14:17
It's just your brain has not developed these shortcuts yet, these tricks yet.And like an expert, there's nothing to do with your skill level or your worth as a person.That's just going to take time you when you suck.I said that to new grade ones who was, I was chatting to somebody and she was a little bit down on itself and I said I, I don't understand why your expectations are that you're not going to suck.14:40
How many times have you done this?Before, of course, you suck.Just give it a minute time.Yeah, yeah.And I think you know as that's we're not good at that, right?Like we're, we hold ourselves to a really high standard and I think that's really hard as a new graduate to accept that you're not good at it and also that no one around you should be expecting you to be good at it.15:02
We should be helping them to get there and normalizing that.And that's, I think one of the hardest things about being a new clinician.And you know, now that you're an expert, like when you don't know something, you don't think it's because you're not stupid.You think you know that that's because like sometimes medicines hard and you just don't know things.15:22
But when you're feel like you don't know things all the time, you can't sort out it.Do I not know this because I'm missing something?Or do I not know this because this is medicine and it's hard and it's Gray?Absolutely.That's such a big thing.It's one of my favorite things to hear.When I speak to it especially.15:37
It's like I've got a tricky case and I'm beating myself up.I'm like, I can't crack this one.And then I'll call a specialist and they listen to the whole history and they go, now I have no idea.That's weird.And it's the best thing I can hear.Like, Oh yes, it's not me.It is just hard.Right, right.But you know that now.But as a new grad, you don't know which bucket it's in.15:55
Yeah, exactly.I do you want to ask if there's a risk in this kind of thinking?And this is a risk in terms of for the patients, because when I talk to teachers to high level specialists who teach, they sometimes do caution about the idiolepsis, the heuristic thinking, that shortcut thinking because of the risk of going, oh, I, I see that.16:19
I assume it's that and I go down that road and I fail to do the algorithmic thinking a little bit.And then you miss the occasional thing here and there because.You get a little bit cocky, basically.Yes, I I hear what you're saying.I think to me, the natural succession making and the heuristics, it doesn't replace the other.16:39
It goes alongside and heuristics is really one tiny piece of naturalistic since you're making, it's not the whole thing.So I agree, I don't think we should be teaching people shortcuts.I don't think we should be short circuiting all of the like.16:56
The most common things are the most common, but you also have to be thinking about the other things that it could be and not missing the details.So some of the key features of naturalistic decision making are heuristics, but that's not it.The other sort of things that get you to expert level thinking.17:14
And again, this is like a whole science.So this is like really Cliff Notes version of it.But one of the things is, is tacit knowledge.So that's like you were saying, how do you know what you know?You don't always know it because it's intuitive.It's like built in.How do you know that a thrombus cat sounds specifically like that?17:32
And how do I know exactly what you're talking about?Because I know that too.It's because you've heard it, you've seen it, you've lived it, and you just know that is ingrained in your brain.That sound is attached to what that is and you can't always access like how you got there.17:50
The other key thing is seeing the invisible.So when you say like, I know what an animal has just by their body language, that's you like noticing really subtle cues that you might not even be able to verbalize.And that's a place where we can teach, again, both sides to ask those questions.18:08
So if you say like, hey, I knew that was a thrombus or I bet you that dog has diabetes just by looking at it across the room.And your new Doctor is like, how did you know that?And you're like, I don't know, but maybe we can teach you and teach the trainee to ask some questions to unlock that, to say what subtle cues did you pick up on?18:30
What things did you ignore?And then teaching the mentor to ask some specific things to the trainee to try to help them build those skills.So what did you notice about the dog from across the room that maybe you didn't even stop to look, but like, let's just look at the dog from across the room.18:45
What do you notice?What am I noticing that?What am I noticing that you also see that maybe I'm ignoring.Why am I ignoring that?I think it's diabetes, but what else am I thinking about?What else do I think could be going on with this dog that I'm going to make sure to rule and rule out?So again, it's not just these shortcuts, but it's teaching people to unlock those other things that you do automatically because you're an expert that you can't explain unless somebody really specifically asks you about it.19:13
OK.So that leads nicely into what I want to discuss next is can you speed up that process And it sounds like you can because I want to know.So we we've established that it happens and it's hard when you don't have it.Can we take people who don't have it yet and speed up that?19:28
And it's what you're discussing.Is that how we do it?Yeah.So I think we're in the early process of figuring out how to take this whole social science of naturalistic decision making and bring it into the clinic in a way that really helps people unlock this.And then does that I think speed things up is a question that I, I don't know.19:49
I imagine it should, but I don't have data to prove that.And then to not only speeding it up, but does it let our trainees get to a level of expertise that not everybody gets to, I think.20:05
And so how do you know does it?Help more people get to a higher level of practicing medicine and teaching too.So those are questions that I'm really interested to know more about, you know, and have more data for.20:21
I don't have that yet, but I think the way people have responded to just starting to talk about it, we're in the early phases.This is the first year that we'll have a module that all of the trainees in our program will have about naturalistic decision making and all of our mentors will also have, we've put it into a couple of hospitals, but it will be international training program this starting this summer.20:46
Then having the questions, having people like bring those into the clinic, I think is the next phase.Like how do we, I, there are a couple hospitals that sort of put a question of the week up that come from naturalistic scissors making that come from our Bank of questions.21:02
But we don't have like a systematic way that we're putting it out yet.So I think it's this has been again, like rattling around my brain for a long time and it's going to keep rattling around and keep trying to figure out how to use it to enhance what we're doing in the clinics.21:21
I'm going to interrupt you for a minute to brag about our clinical podcasts.So you're listening to a conversation about the kind of expertise that you can't learn by yourself.This is exactly why I do the clinical podcasts the way I do them, Picking the brains of experts who have seen hundreds and hundreds of cases, who can share the kinds of insights that can help you make those kind of connections that you will not find in a textbook.21:44
I have to brag a little bit about the podcasts.Two things.Last month we released episode 200 on each of the three streams.So that's medicine, surgery, and ECC.In other words, we now have more than 600 episodes out there in our clinical stream, all of them backed up by our now famous show notes and the AI search tool.22:02
And we're still trucking along with two new episodes per week.The second thing I want to brag about is my favorite testimonial that I think I've ever gotten for the podcast.I was at a conference last week and a vet came up to me and said I'd love to give you some feedback.So I said feedback on the clinical or the non clinical podcast.22:19
She said no, the clinical I'm a subscriber and she looked a little bit serious so I thought maybe this is not going to be good feedback.She paused for a minute, and then she went.They are fucking perfect.Please don't stop what you're doing.Please keep doing them.They mean so much to me.22:35
So there you go, my new tagline, Vet Vault clinical podcast.It's fucking perfect.Go and find out if this is true at vbn.supercast.com.OK, let's get back to Doctor Annie.I like the G talk mentors, not specifically teachers.I I almost feel like this is a mentoring skill.22:54
So as a teacher I'm going to teach the fact I think of you as a lecturer teaching a bunch of pre grads and these are the deities blah blah blah.Whereas mentoring is exactly this.It's the stuff that's not the textbook stuff really like I'm trying to think of outside of veteran science where this sort of stuff happens.23:15
I do this when my kids when we teach, if at the moment my kids are really getting surfing, which I serve.And I find when we're out there, when on the beach, I could say, well, this is what you're going to do.There's the techniques and stuff, but is when you're out there, I'll be like, oh, watch out the way the currents moving there.23:31
That's going to cause something there.Well, watch this guy.Oh, that's there's these little subtleties that I've picked up over 20 years of surfing that I could talk them through when they're in there with me that I know it's going to take them 1020 years of experience.And and I think you could do this in with practice as well.Is that how you think we're going to teach?23:48
It is just to say out loud what's happening in your brain.Yeah, I think that's part of it.I think.I think really good teachers and mentors do a lot of these things naturally, But being a good mentor, being a good teacher is also a skill you can learn.24:03
And I think to me, that's something that's really core of the work that I do now at Ethos is being a good mentor is not just being a good clinician.There's a whole other skill set, and some people are naturally really good at some of those things, and some people need to build those skills more intentionally.24:21
But they're all skills.And if you're really good at externalizing your internal thought process, then maybe part of this you're really good at naturally.And part of it is you as an expert have to recognize some of those thought patterns are not accessible to you unless you really think hard or somebody asks you a specific question.24:40
So when you're teaching your kid to surf and you're teaching them the things that you're paying attention to, you're doing exactly that.But you could just as easily go out there and not say a lot or say like go catch that wave, which somebody else might do.So I think it's it's a whole world and a way of thinking and a way of approaching being on the clinic floor with somebody who doesn't know as much as you in a really intentional way.25:10
The only problem with my kids is they they don't want to listen to my wisdom.They can have it on the wet floor as well, isn't it?Yes.I mean some of it too, like is this going to speed things up?I think that's a hard question because some of expert level thinking comes from living it and doing it and making those neurons linked together in your own brain.25:35
And so some of it I think probably you can't speed up, but I think there are parts of it that you probably can and that you can get to.You can go from entry level to solid good clinician, probably in a shorter amount of time if you're learning how to think as you go.25:56
I'm curious when we talk about mentoring, what does mentoring look like in the Ethos hospitals?Do you have a structured mentoring program where certain people are assigned as mentors or is it just a culture of mentoring where everyone's a mentor because it is.I don't know.26:12
You talked earlier of, I think you said the term imposter syndrome and it's, it's hard to back yourself to believe that you it's, it's a bit of a process of or a way of thinking of who am I to start telling you what to do if I'm not officially, you know, I'm not a specialist.26:29
So, and a lot of these things that we're talking about, they my internal thought processes.So I don't know if it's worth sharing when there's the textbook and I don't want to teach you my bad habits, having the confidence to act as a teacher and a mentor because when I, you know, we're going to call this episode How to be a Better Teacher, which feels like it is only for the officially ordained teachers and mentors.26:52
But really, we all have that opportunity to teach and mentor.How do you guys do it?Yeah, you make a great point of like, a lot of the way we're framing this is like, you're the expert, but that means you have to think of yourself as an expert to be able to, like, put yourself in the shoes.27:07
Yeah, it's a great point.So mentoring to me means like really helping someone achieve their goals by sort of helping the whole person.So I think being a good doctor is so much more than just the medicine, right?27:26
It's all of the professional skills that go along with that.And so again, when I think about like the support that we can provide to our hospitals, to our trainees, to our mentors in the hospitals, we really want to sort of wrap their clinical medicine in with all of those extra things and both in our mentors and in our trainees.27:48
So specifically the way our programs work are all of our immersed training programs in the hospitals have a local champion mentor, at least one, sometimes they have a whole team.I would love to get to a sort of place of a culture of mentorship and teaching.28:08
I think we're we're not there yet, but building those local champions.And I think the way that I see my role as supporting those people is giving them a toolkit, giving them the skills, giving them the space to connect with other mentors, to learn from each other and to build that identity as a mentor.28:27
And all the things that the day-to-day silly things like an expectations guide, procedures list, all the things that every hospital sort of recreates when they make a training program.Just having all of those things available for people.So they're not building that from scratch.28:44
If they have a question about something really specific, connecting them to another program that may have figured out that also struggling with that problem or figuring that out too so that they can share what they've learned, things like that.And then we have a national didactic curriculum that we deliver that is competency based that again sort of wraps the the medicine and the professional skills together.29:08
Back to the naturalistic decision making, you mentioned the questions, the standard questions around this are the questions just to get people to think in this way, to keep it top of mind.Yeah.So in the process of trying to figure out how to bring naturalistic scissor to making to the clinic, I reached out to somebody who's in this world.29:29
He's a social scientist who has a consulting site and his website had a very friendly, like, you know, reach out to me.So I did that thinking he'll never get back to me.But he was really excited to work with the veterinary space and he's become a partner in sort of helping us understand the science more and then developing this list of questions.29:53
And then we actually also my partner at Masvat, Ali Pavoda, who's an ER doc there, who now runs the program at Masvat, and I and Brian Moon, who is the naturalistic decision making expert.We actually developed a game together that he sells through his company that is not domain specific.30:12
So he sells it to like railroad company people, government type people.And we've used it in a couple of the veterinary settings where we have a group of trainees and mentors.And that just gets people in the idea of what naturalistic decision making is, how to ask those questions.30:30
And then we've come up with kind of a list of questions that people can put up in their clinic or keep on their computer desktop just to think about as they're going through cases.Can they ask one or two of these questions to again, try to unlock this thinking?And I think even.30:46
Just having people understand kind of the background of this helps then for them to speak more of the same language when they're trying to understand what's happening with the case.So what sort of questions do you have?Anything top of mind?I'm just curious, what would you put on the wall?31:02
Yeah.So like what information did you ignore?What subtle cues did you pick up on?What did you notice that maybe, you know, I didn't notice.So for example, when you're looking at an animal breathe, like how do you know that it's restrictive or obstructive?31:21
Those are really subtle cues that you're picking up on in seconds and then reordering your differential list.How can you externalize that?If somebody asks you a specific question, what are you tracking in the bigger picture?So I think experts are often thinking 3 steps ahead.31:37
They're thinking about, like you say, you know, kind of ruling in, ruling out in that first couple of minutes.So both sides asking like, what's the bigger picture here?What are you tracking?What do you think is going to happen three steps from now?What's OK not to know right now?31:55
What does bad look like?If this goes bad, what is that going to look like?So there's something called a, a pre mortem, which is basically imagining the worst case scenario, all the ways it could go wrong and then talking through both what you would do, but also like how do you avoid getting there?32:14
And that can be really helpful again, for the expert to break down their thinking and then also for the novice to start thinking like that, start thinking like how could this go wrong?Because I think in the ER, a lot of us are always thinking like that.These are the ways that could go bad.32:29
These are the things I'm going to do to try to prevent that, or these are the questions I need to answer right now to prevent that.Yeah.So using the pre mortem as a way to have the expert breakdown their thinking and have the novice start to develop that type of thinking.32:45
So I think that really encompasses kind of how I think naturalist decision making can really help both sides to again develop really how to think about a case as opposed to what is the next step for this specific case.33:02
I really like that listening to you talk through that.I think something else I do in communicating that sort of thinking, I'll do it with clients to some extent.Obviously not, not all of it.I know this, this and this.I know it's not this.If shit's going to go really wrong, this is going to happen.33:20
So, for example, when I discharge an an animal, I will talk through my thinking to some extent.I'm like, well, in the time we've had for now, I've ruled out these things.I I think it's this, if I'm wrong and it's going to go South, the animals going to do that and then you should come back to me straight away.That sentence or or explaining some of that thing to clients, I think has saved me a lot of complaints and a lot of stuff UPS.33:41
Just even just saying that sentence.If I'm wrong, it's like a door opening for them.You go, oh, they don't know everything.But it's not an admission of weakness.It's just saying This is why I think what I think.But if I'm wrong, catastrophe looks like this.Yeah, it's a great point.33:56
I think all these skills translate into better client communication as well.And I think, again, the people who naturally good at this, you know, sort of develop their own style and interpretation of kind of doing exactly that.But again, it can be an unlock for somebody who's still learning.34:13
Like, how do you have this client conversation in the best way possible?How do you give them a recommendation, but also lay out all the reasonable options and tell them why they're the reasonable options and what might make them want to make one decision over another?What could go wrong here?34:29
How does this case usually go?What might make your case not go the usual way?You know, those are all really good naturalistic decision making questions for all places in the clinic, including with clients.It's really interesting.34:47
I had a mental deep dive on AI in my clinical work.I use a lot of AI in my podcasting work and that then I'm starting to use it more in clinic as well for clinical decision making, which it's very good at a lot of stuff, which I sometimes have almost an existential crisis of going shit, What's our job going to be?35:07
But I think you've I've just been listening to you realized to a large extent what our job is going to be for now.Maybe it can get better, but the Cha chi PT or the whatever AI models, they don't do naturalistic thinking.It's algorithmic fact based.So maybe the collaboration between US and that sort of information source can be, I do the naturalistic thinking and then exactly the sort of stuff that I said before.35:33
But what am I missing in jumping to conclusions, in taking a mental shortcut, Take that to Ted, to BT and say, here's what I'm, this is what I'm seeing, here's what I'm thinking.Check me.What am I missing?What other differentials that I should consider?Because it's very, that's sort of what I'm using it for.35:49
And that might be a perfect partnership.Yeah.I mean, this could be like a whole whole other podcast talking about AI.But, you know, that's something I'm thinking a lot about is, you know, what is the next iteration of our training programs going to look like in a world of AI and in a world where you're not going to have to know very many facts, right?36:09
Like because the facts are all there.There's all those flow diagrams that I talked about earlier are irrelevant.I don't need to know them anymore, but I don't need to go through it because there's a another brain that does that for me.Right.So then what you know, what should we expect our doctors to know versus not know?36:29
How do we teach them where to get the information?But then also you have to have enough critical thinking to question the AI and ask the right questions, right?Because otherwise you don't get the right answers.Or it gives you something that you as an expert might know is not quite right, but you might not know that if you're not, you don't have that.36:52
So I agree, I think it's really interesting to think about what is the next generation of doctors going to look like that have AI and what do we need to teach them?How do we need to change our training programs to help them be successful?It's a whole other set of questions, but I love your idea of the AI, the naturalist, consider making questions to help you.37:16
I think that's really cool.I'm going to play around with that.Cool.All right.Can we take a complete pivot away from mentoring and teaching something else that you're passionate about in your speaking and your research?From what I looked through your bio, I'll start with a quote from yourself that I saw the blog somewhere.37:35
There's never a good time to get a puppy or have a kid.Yes, in your in your questions that you sent ahead of time, you were asked what the advice is.And that's something I still say a lot.There's never a good time.37:51
And really what I mean by that is, you know, sometimes your personal life and your professional life align, and a lot of times they don't.And I think you sort of have to make decisions that make sense for your personal life and figure out the career as you go and figure it out.38:07
And, you know, you never know what opportunities are going to be there.You know, like we were chatting before, neither of the jobs that you and I have currently existed when we graduated from vet school.So you just don't know what the future is going to hold and what the opportunities are going to be.38:25
So you kind of just have to take the leap if it's right in your personal life.So kids, puppies, I, I was going to say it's easy to deal with puppies, but I, last time I had a puppy, I was actually shocked how hard it was.I thought that after having kids, having a puppy would be a breeze.It was not.38:40
It's the, it's the, it's still hard.You are, you're a mum of three, so you're a criticalist, specialist and a mother of three, and you talk a lot on pregnancy and parenting and for veteran students and veterinarians, right?38:56
Yeah, yeah.So my personal story, I got married in vet school and then in my internship in residency, you know, we knew we wanted to have kids.We knew we wanted to have more than one kid and we didn't want to wait.39:12
And I actually had my son when I was in my second year of residency.And it was challenging, for sure, and really scary because no one had really done it.There had been one other internal medicine resident who'd had a had a kid in her residency, but it really just wasn't done.39:34
And telling my bosses that I was pregnant and going to take some leave when I was a resident was terrifying.And there was nothing written down about a policy of what that could look like or, you know, how much time I could ask for off or what it would look like when I came back.39:54
And, you know, I think just that not knowing how people were going to react, not knowing what the options were was really scary.And I think, you know, I'm relatively lucky in that in the end, everyone was really supportive.40:11
And I had a residency that far exceeded the requirements of on the floor time.So I was able to take 12 weeks off and still finish all of my requirements, my residency and sit boards on time.And I was able to take 12 weeks at home and going back even after 12 weeks was really hard.40:31
And then I had two more kids and I had my second 2 when I was in academia, which actually had the family leave.With my second, I actually took 16 weeks where I had 12 weeks full pay.And then I sort of stacked some PTO on at the end.40:50
And then with my third, I took 12 weeks and then I came back half time for 12 weeks, which was that was amazing.So, you know, I was able to do it, but it wasn't it wasn't entirely smooth.And I'm lucky in that, you know, that was kind of the time I was able to take.41:09
Most of veterinary practices in the US still do not have paid leave for mothers or fathers.And it's very state by state what kind of FMLA type pay you get.And I think there's still a huge stigma with having kids in vet school or during your training.41:33
You know, in some of the research that we did, we collected both statistical quantitative data about how many vet schools have written policies, but we also collected a lot of qualitative data of just people's experiences.41:48
And I think the vast majority of people having kids in that school and during their training do not feel supported and in many cases feel stigmatized by making that decision.And I think mothers much more than fathers.It's it's hard and you know, your, your peak time to have kids overlaps with your training.42:10
And I think, you know, we still have a long way to go in terms of changing how we structure things so that it is like we just accept that that is the reality and we should structure things to support people in those decisions.42:27
Yeah, when you say there's never a good time to have a puppy or a kid, I do feel like your second year of residency, it's it's possibly the worst.I've not done a residency, but I know people have done it.So it does feel like, OK, wait, let's make a hard thing much harder.42:43
Let's take two of the hardest things you can do and combine them into into one fun period of time.Why?Why?Recommend it.You did it.I, I stories like that does always make me think, wow, you do a hard thing like vet school to be pet school was plenty hard enough and felt almost impossible.43:03
And then somebody adds that layer of complexity and still gets through it.And then you go, all right, maybe it's not that hard.Maybe I, I could have you can do more.There's it is possible.It's humanly possible to achieve these things.Yeah, it it, you know, it worked out.My, I, I actually, the way it all happened, my resident mate had been out in practice for a while and was coming back to do a residency and she had six month old twins when she started.43:32
And so that was helpful in just being like watching somebody else do it.So she, you know, we shared an office and we would pump both pump in the office and like share early parenthood stories and, you know, we really got each other through and I don't, I think it's unusual, but it was, it happened that way.43:54
And I feel lucky to have had her kind of to help me figure it all out as we went through it.It was hard.It was hard.But like I say, you know, like, I knew I wanted to have a big family and more than one kid, and I didn't know if it was going to be, you know, we're going to have fertility issues, and we're lucky that we didn't.44:17
But, you know, I think that's sort of the next layer I think, of looking at the research is, you know, how many people are putting off getting pregnant?And are there higher rates of infertility in the veterinary population?44:33
There's been some studies in human doctors looking at, you know, they do have higher rates of infertility because they're putting off getting pregnant until after they're done with all of their training.And that's a different kind of stress.It's so I think it's they're all hard decisions.And the veterinary profession, it's now mostly women, but I think it was built by, you know, white men who had women who stayed at home.45:00
And I think we're we're left with a legacy structure that still does not really recognize that the vast majority of people in veterinary medicine, not just vets, but all of our support staff too, want to have kids, want to have families, want to be able to do both.45:19
And I think there's a lot in our structure that could be different to support that.Yeah, you mentioned that stigma and I was trying to assess my own response.When I hear somebody is having a kid during vet school or and you're right, I just go.45:35
That's why would you do that?They just don't go together.Pick one, right?It's you can't.What did I hear yesterday?Somewhere you can have everything, just not at the same time.Yeah.But but you're right, the conundrum that you posed there it is that age thing, is that why you decided to go the hard route?45:54
How old were you at the time when you were doing your residency, if I can ask?So I was 29 when I had my son, or 30.I just turned 30 I guess.Is that why you decided to do it?You were like, well, we're not getting any younger.Let's that this has got.46:10
If I'm if I'm going to do this, it's got to start right?Yeah, and, you know, I knew friends that were having fertility issues and that we're going through IVF and all of that is so stressful and emotional as well.46:26
And I'm, I'm the oldest of four.So I grew up with a big family and I, I knew I wanted to have a big family.And so I just, I was, I was more afraid of waiting and wishing that I had started sooner than starting and figuring out.All right, I have to laugh at that.46:44
I'm the youngest of four, which is why I knew I didn't want too big a family.So from the other end I went no.I stopped at 3:00.Saturday, Saturday, I was going to say our scenario is not that different.My wife's a vet as well and because of exact and and that wasn't even specializing.47:01
Our best story was more vet school.I'm a little bit older than her.So when she finished vet school, then there was a couple of years of travel and that and then same thing you suddenly realize, oh crap, I'm late 30s pushing 40 and do we want to have kids or not?And as it was and we didn't wait that long, but even our third one, she was classified as a geriatric mother officially Geriad, which is not a nice thing to hear right?47:23
Geriadic myself, it's.Another way in which you know a woman would have never named it a geriatric pregnancy.No, 100% they should change their name for sure.So how do we make that better?47:39
Like what?What does a supportive environment for somebody who wants to make that decision look like in the ideal world?It's a great question.I mean, I think models, I think the US is probably the worst place for parental leave.47:54
There are other places that do it better.And you know, I think we can't count on our government to support that at any time soon.So I think it's up to practices really and sort of veterinary medicine as a institution to think about the changes.48:11
So looking to the human medical field, which I think is by no means perfect, but definitely has done some things that we haven't really implemented in veterinary medicine, like allowing people to take a research year or making that accepted.48:27
So that if you wanted to have a year that was flexible built into your schooling, that's possible, You know, staffing residencies.So that if somebody does go out on the, whether that's to have a kid or because something else happens in their life, it's doesn't mean that they're completely derailed for a whole year from the residency.48:46
You know, we could structure those differently.I think those are some small things.And then I think just in, in veterinary practices, you, not every practice can afford to, you know, offer paid leave for everybody.But I do think if it's possible, we should be offering a leave not just for veterinarians, but for our support staff, too.49:05
And then I think when people come back, you know, recognizing that this is a huge life shift and having intentional conversations with people about what are the things that are really important to you right now?You know, obviously, the business has to do things that make sense for it.But like, is there a schedule change that still works for the clinic that might make things easier for you?49:25
Where can we be flexible?That's supportive.And I think, again, that's not just important for parents, but it's everyone, right?Like if you're dealing with an ailing parent or my kids are now in school and my son has had a really tough year at school.You know, I've had to flex my schedule to be at all these school meetings.49:42
How can we make sure that people are recognized as whole people?And then that includes their parenting journey, wherever that may fall and you know, not be so rigid.And again, I think it can't be to the detriment of the business working, but I think we're so stuck in.50:00
It's been done this way.It's always been this way.This is how we do it as opposed to how can we make things work for all sides and where can we be flexible and where can we not be flexible?And that needs to, you know, be a conversation you.50:16
Said it when you were telling the story of your residency you said you wouldn't advise it.So what do you advise people in the similar boat?Whether it's fit school or post qualification.I mean, like I said, there's no good time.You know, like if you're an intern or resident, like that's not a good time.50:36
But then when you're first out, like that's not a good time because you're trying to figure out what your first career move is as a specialist.You know, there's always a reason not to.So I think if it's important to you, you should do it and figure it out.And I think also like we on the other side of it need to normalize like it's, it should be normal for a person who's in their residency in that school to have a baby.51:01
It's part of life.The vast majority of people have babies, you know, like it just shouldn't be this crazy thing to do.And I, you know, that I say I don't recommend it, but at the same time, like I don't recommend putting it off and waiting.51:17
And I think, you know, the other options are maybe worse and they're always trade-offs.They're always trade-offs.I don't really know if that's advice, but.No, no.Well, that's it.It's a lived experience and you can share from that and you survive.There you are.51:33
You have a career, you have a job and you have three kids.So it is possible.Right.I, I went on and had another one, right?I think we just need more people talking about it and sharing their experiences and sharing what they want to be different and sharing the spaces where we are doing this really well.51:49
How do we, you know, make our workplaces places that people want to stay even when there's life stuff going on?I think there's a whole other conversation about retention and people feeling like they belong at work and wanting to stay even when things get hard.52:06
And I think this is part of that.Yeah, because from the you're right, from the business owners perspective, it's a scary conversation to have.Even if you have empathy towards this and you get it, you, you, you're still looking at the numbers and going well, I can't afford to pay people for a year if they're not working and and producing, but.52:27
Yeah.The the reality is, it does happen.And I think that that is it's really hard and it's not going to change overnight and not in the foreseeable future, at least in the US right now, unfortunately.So I think one of the other ways that are within reach that we can make things work.52:45
And like I say, it's, it's not just the vets, you know, all the support staff, you know, retaining those.We know that's there's a huge retention crisis and that's expensive too.Turnover is expensive.So thinking long term I think is helpful in these situations too.53:02
Yeah.All right.We should start wrapping up.There's so much I can still talk to you about, but I have to do the wrap up questions.That way you're not going to get away without them.Are you a podcast listener at all?Yes, I listen to lots of podcasts.I generally don't listen to that podcast because I like to have my podcast be like not work time.53:24
My non miss one is Pivot, which is kind of tech and now it's a lot of news.It's really the only tolerable way to adjust news right now.So that's my non the one that I can't miss during the week.And then I have lots of other ones that I listen to depending on what topics they're talking about, a lot of newsy stuff and a lot of science type stuff as well.53:49
The pass along question when I asked the guest a question from a previous guest and then you've got to give me one for the next one.So the question for you is from our previous guest is what is the number one misconception or mistake in your field that you would like to see go away?54:06
Yeah, I think we've touched on a little bit, but I hate the I had it hard, so you have to have it hard as well.I I really want that to go away.We can do it better.You know, it doesn't have to be work 80 hours a week.54:22
So, you know, give up every other part of your life and do it without support or with people kind of berating you for mistakes that you made.I think we can do it better and I wish that this would go.Away so saying I had one that I really like that says pave the way behind you, not in front of you.54:42
I like it.Yeah, I like that too.Yeah.All right.Your question for my next guest please.Yeah.So something we kind of touched on a little bit is how is AI changing things in your everyday work, veterinary life right now?And then where do you see things going?54:59
What do you predict will be the biggest impacts in the future?Oh, huge question.Something I'm thinking about all the time.All right, you have an opportunity to speak to all of the vet new grads of the world by be run a podcast talking to them and you have a couple of minutes to give them one final bit of advice for their vet careers.55:18
All life doesn't have to be vet specific.What's?What does Annie have to say?I mean, I've already given you my best advice, which is no good time for puppies, OK?Cool.All right.So we're going to stick to that.Yeah, but I think, you know, like we sort of were saying, you just never know what's going to happen, opportunities that you never even imagined will be possible and present themselves.55:40
And so just being open and, you know, I think in the US where it's, you know, you go to undergrad, you go to vet school if you specialize and there's like the track is so set for you that when you finish that sometimes it's like, what's next?And being open and not like deciding in five years what you're going to be doing and, and taking the next thing and figuring out as you go.56:05
I think that was definitely a lesson I learned many times the hard way, but I'm really grateful for being open and figuring out how to keep changing and keep evolving my career.It's also great advice for the almost for the other end of the scale, where when you're trying to decide what to do next, realizing that that decision that you're going to make doesn't necessarily just lead to one thing.56:34
So I think of your example, I'm looking at you.So we all most vets at some point sit with a decision.Well, should I specialize?And when I imagine what it's going to look like when I specialize, I picked joke.I'm going to specialize and then I'm going to work in a specialist hospital as a an ECC specialist or I'm going to go into academia.56:51
And that's the closed minded view of the what the future's going to look like, but not necessarily because, you know, you have your specialist degree, but you're not out there doing criticalist work.You're doing completely different work and also very satisfying and very, very useful work.And I suspect that your specialist degree is still one of the reasons why you got that job right.57:12
Totally.I mean, I think all of the the pieces that got me to here informed and allowed me and gave me the skills and the expertise to get to where I am.And you just never know where that's going to be.So pursue the things that are interesting to you and the career opportunities that are exciting and keep you challenged.57:32
And like you say, no decision is forever.You know, you're not, you're not making this decision for the next however many years.It's just the next thing and there's going to be another opportunity that comes along that might be interesting that you also want to take.Amazing, Annie, thank you so much for spending the time and thank you for putting another thing into my head.57:53
And to our listeners, heads that can rattle around in there.I'd love feed feedback from other people.If anybody has experience or thoughts on naturalistic decision making, let us know.But I I really appreciate the time.There's an awesome discussion.Thanks, me too.Yeah, I definitely want to hear about if anyone's thinking about naturalistic decision making as well.58:12
We can thank.You for having me?Get in touch with you if anybody is curious or has any insights or questions about it.Are you reachable?Oh yeah, it's just my ethos. e-mail annie.wayne@ethosvet.com.I'd love to hear from you.Before you disappear, I wanted to tell you about my weekly newsletter.58:35
I speak to so many interesting people and learn so many new things while making the clinical podcast.So I thought I'd grant a little summary each week of the stuff that stood out for me.We call it the Vet Vault 321 and it consists of three clinical pearls.These are three things that I've taken away from making the clinical podcast episodes, my light bulb moments, two other things.58:54
These could be quotes, links, movies, books, a podcast highlight, maybe even from my own podcast.Anything that I've come across outside of clinical vetting that I think that you might find interesting.And then one thing to think about, which is usually something that I'm pondering this week and that I'd like you to ponder with me.59:11
If you'd like to get these in your inbox each week, then follow the newsletter link in the show description wherever you're listening.It's free and I'd like to think it's useful.OK, we'll see you next time.
