Kat Cheng

Welcome to Episode 8 of "It's Notts Just Physio." We are delighted to have the brilliant Kat Cheng on the pod with us! 

Kat shares her experiences within her role in safeguarding at the School of Health Sciences. Safeguarding is a crucial aspect within the world of health care, as well as for our own general well-being. We appreciate that this topic can be quite emotionally heavy, so please be warned throughout. Tune in for an insightful and important discussion!”

For any students listening who feel they to talk to anyone regarding the content in this episode, please contact your personal tutor or Kat Cheng kat.cheng@nottingham.ac.uk (who is with us until October). Or go to the student wellbeing page: https://www.nottingham.ac.uk/currentstudents/wellbeing/student-wellbeing.aspx 

For any non-University of Nottingham students listening who have been affected by this episode, we advise you to speak with your GP or a healthcare professional. There is also the website for Mind https://www.mind.org.uk/information-support/local-minds/ which may also be of help.

Transcript

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[Seven Dark Lords - Glad Ghosts plays] Hello. Welcome back to It's Nott Just Physio podcast with me, James Coughlan. we're on episode eight. which is really exciting and what you should know by now, this pod is designed for its listeners to get to know our wonderful staff and students within the School of Health Sciences at the University of Nottingham, and get to know them a little bit more. And I'm absolutely delighted to have Kat with us today. Hello. Hi, James. Nice to be here. That's really great. And, Carla, when we planned this part, we wanted you on air for for quite some time. So I'm delighted that we're doing that today. No pressure. No, no, no pressure at all. No pressure at all. but so thanks for joining us here. So let's start off, tell us a little bit about tell the listeners a little bit about yourself, who you are. What do you do here within the school. And we'll take things on from there shall we. So, my name is Kat Chang. I'm one of the teaching associates within adult nursing. So that's where the most of my teaching kind of lies. but within the school, one of the roles that I hold is deputy safeguarding lead for the school. But I lead on the nursing aspect mostly, but I still support our safeguarding lead, with potentially instance or things that might happen to students across the school. And when did you start that role? So I started work at University of Nottingham in 2021, and from my experience in practice, I've done a quite a lot of different safeguarding, elements to my role and I felt quite confident with safeguarding, and so I quickly aligned myself to the safeguarding team, kind of help them with some of the teaching aspects. but within within a year of being at the University of Nottingham, the deputy leader safeguarding was rotating out of her role. She was going on to do something else, and I felt it would be a really nice fit and a transition for me to kind of step up and take that role, and do more than just solve some of the teaching that I'd been doing in my first year. So those listening, some people might go, what is safeguarding? What is that? Would you be able to give, an explanation of what that is? And, and just so people can so I understand a little bit more about where this where this episode is going to go to. Not so lightly. So safeguarding is protecting people, particularly those who are more vulnerable in our society from, from harm as best we can. So kind of providing them with a life that is free from harm is ideal. That's where the safeguarding kind of lies, but where we can protecting, preventing or limiting the risk, that they might experience from someone else. So that's the key element there, is that there would be somebody causing them harm. So you might consider it like a perpetrator. that's kind of how we have to work out. Is this a welfare concern or is it a safeguard thing. Is there a perpetrator causing harm to to a vulnerable person? And from your your clinical background in nursing, take us through a little bit of that, because obviously you came here in 2021. Where did you start your your clinical side of things? You didn't take us before that really just not see the flow of your your your exciting journey. Really? Sure. So, I'll kind of talk you through kind of the where I got to the point where I was for most of my career before I came to the university. So, as part of my nurse training, we had to have, time within different fields. So I'm adult trained. And as part of my two weeks of child placement, I went, into a sort of deprived area, further north than we are now and spent two weeks with health minister in the community. That was my kind of exposure to child field. And whilst there I visited families where there were safeguarding concerns. So there was some with domestic abuse, some families where there were concerns about gang involvement or substance misuse. and all of this was impacting the child and particularly the younger children. So, with health, is your focus predominantly is the naught five. But you do have that think family approach. So you have to consider everybody's needs. and the health sisters, unlike kind of other areas of, of practice, might be in the house for, for up to an hour. And actually you get to build that rapport with the families over the visits. And it was there that I saw, okay, this is an area of nursing that I've never been exposed to, and I could really see myself here. It's not that I didn't enjoy my hospital placements or placements in other areas of primary care, but this just really opened my eyes to something that I was passionate about. and there was a big element of public health and health promotion to the role too. so after I qualified at the time, the done thing was go and get more experience before we get into the community. So I did that, but I didn't lose my health. This thing bug and I came to Nottingham in 2016 and did my health training and have since stayed and became qualified as a health visitor, worked in more deprived areas of Nottingham and there worked with a variety of different safeguarding cases, cases where most of quite often the child was vulnerable. But sometimes some of the parents were also vulnerable in that family. and there were concerns that if the child would be was being cared for appropriately by their parent or caregiver. So that's kind of shows you sort of the history and the journey that I've taken and then spent several years in Nottingham, working with families for different safeguarding reasons. I mean, it's, a really interesting journey on, on how, you know, you are on a, on a, on a placement doing, again, sort of a typical caring role, but then this, sort of, this experience must have been a real I mean, I don't know how you must have felt being in that moment. Did your training prepare you for that moment, or was this, I've never seen anything like this before. But you know what? What did you do? You remember how you felt going through all that? I guess at the time? safeguarding is embedded throughout a curriculum because it is something that, as healthcare professionals, we always need to have at the back of our mind. Not that you're second guessing your patients or their families, but if you have that gut feeling, that professional curiosity, as we call it, that something is not right, that you don't just say, oh, I'll give it the benefit of the doubt and I'll leave it. You kind of dig a little bit deeper, perhaps, and sometimes that's really hard to do, particularly if your consultation is short or you're not seeing the patients regularly. But I found that with health is seeing with the frequency of the visits and seeing them and seeing families and clinics and things that you got to know them more. And naturally you have often that space time and reported ask routinely if somebody was experiencing domestic abuse, if you suspected it, or financial abuse or any other kind of abuse that you suspect, maybe even coercion and control, which is even harder to, to evidence sometimes. but sometimes that, yeah, your gut feeling, your professional curiosity, you know, there's something that I think all of us do develop over time, and it comes with experience. but it's something to it's something that you don't just want to leave you. You think, if I leave the family now and I'm going to worry about them, I'm not going to think about them. And I know that happens for us anyway. but I don't think I was fully prepared for it because I hadn't been in that situation before where there had been quite a hostile partner. in one of the visits. but I was really glad that my, the person I was working with at the time exposed me to that, because she did warn me. She did say this family, they are on a child protection plan. and if the partner is there, then they're. You. well, it wasn't for me to say anything, but, just that he might be quite intimidating, so I was kind of warned about that going forward or going into the visit. and he was present, and I did feel intimidated, but, the health is too that was there. Handle it wonderfully and kind of would always sort of keep a foot in the door for coming back. So I think on the visit I went to, she said that her scale, her brain calibrated. So I'll come back in a couple of weeks and come away the baby or the child and see how they're getting on. In actual fact, they weren't. But you kind of come up with ways to keep families engaged or, you know, to to come back. it what am I ask? Might be it might be a little too broad to answer, a bit too difficult. But you it typically. Well, in that particular scenario, your senior, let's say your colleague, gave you some, pre warning to a degree that there was a plan in place in that. But if you if you didn't have that pre warning, are there any particular quite obvious signs that might present in a patient group where you might start to suspect there's something going on here. So I'm just thinking for people listening to this who might be embarking on their first clinical experience, anything that might give them a little bit of a guidance and to think, oh, I might need to look into that. I need to be aware of that. and I guess the key thing to know with safeguarding is that it can affect everybody. It doesn't it doesn't only happen to one gender or another or certain ethnic background or a certain age group, it can happen across. So, whilst my focus was the under-fives in that and their families, it is relevant for all of us to consider. So I guess examples of this that our students might be coming across and in placements could be when, if a family member is adamant that they want to interpret for somebody, and best practice is always to use an independent interpreter, whether it's through language line on the phone or having them face to face during your consultation, visit what it sheva appointment that the patient's there because you have. If it is a family member, can you really be sure that they're giving them? Well asking them the questions that you are asking, are they kind of twisting that? So it's something that they want the patient to hear or to answer or to divulge. another kind of more obvious thing might be if you notice bruising on a patient in certain places, soft places, sort of a soft skin where, bones are sort of less prominent underneath. So it's often the face or even finger marks along wrists, things on the arms, even burn marks, scratches. And, you know, I'm not saying jump to conclusions with everything, but sometimes you can say, well, how did that happen? That looks quite looks quite painful or quite nasty. and sometimes people will change their stories and that can be a bit of, a tale that something's not quite right there. If their partner with someone close to them is with them, and they answer for them, not just around how they have obtained these marks or bruises, but, they might be answering questions for the more generally, not giving the vulnerable person the chance to speak for themselves. Again, controlling what information is passed to the healthcare professional. and that's an element of, of control there or coercion, if they're saying, well, will you tell them about what we did last week and that they're influencing what their relative family member partner is saying? I guess financial, if someone comes in demanding money from a patient, if it's a relative or, you know, constantly asking for pin numbers, different cards, again, these things, you know, I'm not saying if you see this, oh, therefore you jump to that conclusion, but it's noticing it having that sort of professional curiosity and thinking, I'm not sure if that's right or that doesn't feel right. but you obviously have to pick your moment of when you try and address it, because that has to be handled quite sensitively as well. And also seeking support from those around you if you're in practice. So if, if, a student was on a placement and they were involved in a consultation and they were starting to have some questions, like you said, of started to see some things or listen to some things, what advice would you give them to then? Do at that point, as you rightly said, not to jump to conclusions? But what what should they then do with with that information? so when, for students, when they're in placement, if they are worried or suspicious about something, it, during that consultation might not be the best time to ask your supervisor or assessor. So it might be something you make a note of on your, and, and ask them at the end when the patient's not there, if you think, oh, I'm just something about that interaction between the patient and the relative didn't sit right. And see if your assessor or supervisor can provide more of the context, because they might actually know, if, say, someone, one of them is on a new medication and it's making them more, more fatigued or, they might know, they might kind of recognize if it's kind of the normal presentation for somebody and say, well, no, they're not normally like that. Actually, today they were more tearful or more shy than they have been previously. So, definitely seeking that that context area, from your supervisor assessor. But if it's something that actually they agree with you is, is, kind of meets that safeguarding criteria, then you would consider contacting the safeguarding team in your trust, even if just for advice. if you did need to make a referral into social care, then they can talk you through that. But as the person that witnessed it or identified a concern, then you would be reporting it because it's from your interaction with the person. But as I say, you would do that as students. They would do that with support of their supervisor. and the safeguarding team now is that's great too, to get that nice and clear because, because I can imagine, you know, having that process, validated in terms of what you need to do, obviously, for students is really is really important. And in terms of like patient groups, are there any statistics or, you know, type of, patient groups that might be more susceptible to safeguarding issues? Or as you said earlier, I mean, this could happen to anyone? again, just thinking from even a student point of view, just to kind of add a little bit of that knowledge, background knowledge to maybe some of that clinical experience is going forwards. so, it's so many different statistics. I could tell you, James. but the ones I'm going to pick up on just because of, I guess my prevalence when we see them, 1 in 4 women is likely to experience domestic abuse at some point in her lifetime. It's 1 in 6 for men, so it's less. But it's still, you know, 1 in 6. and particularly, for topical things when football happens on England, men play afterwards. Then there is a 27% chance of increase in domestic abuse and they lose. It goes up to more like 40%. So it just shows you the impact of a sporting event. now that doesn't mean it's not fueled by other substances as well and other situations. But looking at the stats when England play and the number of police call outs, I speak for themselves while I mean, that's just I mean, it's just frightening. so we were quite scared whenever England men. Yeah. Football and the next day or the next few days. Well what course we were going to get or who social care was going to say, you need to go and visit this family and you worry, you know, grunted domestic abuse predominantly the victims are female then not only but predominantly. and how many children are caught up in that as well? So it doesn't just have a small impact, it can have a huge impact on a number of people. So I know that's quite stark, but we can't if we don't acknowledge that and recognize it and take it as serious as the numbers say, then we can't learn from it all. Recognize what we can do to reduce that where possible, prevent it from happening at all with the current state of the NHS, social services availability, to get GP appointment, these type of these type of things are ongoing at the moment. From what you're saying, if these things are happening in the community, this must make it even more challenging how these things can be addressed and and help helping people. What have you seen with that? What people? How is that going with with within some of those constraints. And you know, there are options for people here. it's really tricky. I, I fully appreciate the, the situation that the NHS is in, secondary and primary care, all aspects. And it's hard enough for us to get GP appointments, let alone, you know, families that are in these kind of situations. It relies on having professionals that are able to identify, recognize, escalate and not not just say, oh, you know, it's a is a Thursday afternoon, I'll leave it till tomorrow because you don't know if the situation will have changed by tomorrow. And I know that that seems quite extreme to say. But unfortunately with safeguarding people, worst case scenario, people will lose their lives. which can which is obviously, understandably really sad. And, you know, if you look at serious case reviews and the history there, they always look at what's the learning, what could have been done differently to have intervened earlier or prevented some of the serious things from happening. And it it when you look at that, in case you see these stories, don't you just think, why didn't something happen early on? What, you know, if there was an opportunity there, why? Why didn't something happen? And I guess, those processes often, you know, have to be reinforced. They have to be, clear and, and acted upon. You talked about how, you know, for example, as a student on a placement, they would have, you know, senior there would often be a, you know, safeguarding team within the hospital. And I might be asking hiccup a little bit too broad here. You might not be able to answer that all. But you know, say someone wasn't in those environments and things, you know, with like, or if they might have seen something, experienced something and they were like, well, I'm not in a hospital. is there any sort of general advice you'd be able to to signpost people, give people options of what, what what they could do, what they should do? Yeah. So I think, linking to that, we know that, you know, our students, when they come to university, they all have had different backgrounds, different experiences in life, and some of them can, reappear or, you know, make themselves visible. Now, students are away from home, students are testing boundaries and finding independence, possibly for the first time. And, you know, if they've left, left home, come to another city. so at the University of Nottingham, if an incident occurs to someone associated with the university, whether they are a student or a member of staff, we have something called report support. it is an online form, that people can complete with their details so that they could be contacted after. Or we have an anonymous version where they don't disclose their details and they can essentially disclose what has happened. when they do include their details or some identifiable information, we can offer further support. So it might be that we consider if our mental health advisory service is useful, or if maybe we need to put them in touch with a sexual violence liaison officer. or it might be that we inform their personal tutor, but we manage it on a lower level. there's so many different things that people can report on there, from assaults to harassment to bullying. and we see lots of different things from students across the university. reported through this. So I'd also encourage students, if they do witness or experience something themselves, to speak with their personal tutor, because, you know, your personal tutor is there for pastoral support. Often these things come to light when students are in preparation for their assessments. and again, personal tutors or even members of the safeguarding team can support you in certain extenuating circumstances. You know, if what has happened, we can detail some of the impact it might have had on you without detailing what has actually taken place. We can say the safeguarding team is involved. Maybe there's a police incident number, depending on the nature of the incident, and make sure that also you get the support you need, because it might be a short term element, or it might be that a student has witnessed something involving a patient. actually, then that student is subsequently asked for a statement of what they feel happened. And again, that's another part of our role. We support students when those kind of incidents crop up. Not thank you for clarifying that. So the report in support any Nottingham student can access that on the they just have to go on the main home page so they yeah. Or Google and and it comes up back doesn't it. and it's, it's, it's actually really quite straightforward to fill in. And I think that's, that's something that's University of done really well not to make it overly complicated. And and as you say, it's important to hear that voice. And what would you say to anyone who might be a little bit worried to fill that in? They might. You know, I've some people might say they get into trouble if they if they, you know, use this form, what would you advise would you give to people. yeah. It's really is really difficult because I think often, students and even members of the public think, oh, if I fill in something like this, then I'm going to get hounded or it's going to affect my grades. And and actually, you know, the name is what it says on the tin. It's reporting something, but then it's the support that comes afterwards that we can provide. and I know I mentioned the report support, but we also even have university security, you know, if something was, you know, sort of an immediate emergency, you would call nine, nine nine. That's your kind of ultimate, safety netting. If you're if you're unsure if you want to fill it in or not, have a look at the form. Even if you know you've not got anything to report, but you want to have a look to kind of familiarize yourself with the information is asked of you and if you don't want to disclose your details, you can still report it anonymously. there is an element of it that is data collection, because we do look at what trends are happening. So for example, are there peaks in the year when the academic year when incidents are happening to our students, for example? and looking at things that are happening across placements. So obviously that's something unique to, not only our school, but all the courses in our school have an element of placement, whereas other schools don't. And it's recognizing that the incident that's or the environments that our students may go to where they may experience, an adverse incident. So, you know, I'd say have a look at it first. If you're unsure, speak to your personal tutor or maybe another member of staff that you trust. Say you've been in a lecture about something that has a safeguarding connotation, and at the end of that, you go and speak to the person delivering it, and that person might be able to to complete it for you on your behalf with the information you provide. I've done that before for students where they don't want their details disclosing. So I really have to respect that. and can complete it on their behalf. It does make it difficult though, to then offer the support afterwards. That's the only caveat. So, but we have in the past, when we have had reports come through, sometimes we'll get an anonymous one and then maybe a week later they'll disclose, but with their details. So then it means we can follow it up with support. I say we, I don't get to view every report. They go to a central team on main campus, and if it is one that I would have involvement with. So a student in the school that I might meet up with to see how things are. If I'm going to support them with things going forward, then it would get allocated to me. But I don't get sight of every single one that gets submitted. You know, you touched on there, that's obviously that respect of anonymity. if that is what is required, though, it is a point that if I was that anonymity, it might make certain investigative processes more challenging, more, more delayed, I guess. So there is that sort of balance, I guess. But going forwards in terms of that, do you mind expanding a little bit more on the support side of it? So someone said, okay, I'm going to send something I've not been happy with. I'm going to do this report. It's then what? What would I expect? Maybe on the other side of that, from, from from the university. And I suppose the key thing here is that the university has a variety of different support things. So, each school and faculty has a support and wellbeing team. we have dedicated sexual violence liaison officers. So I know I mentioned that one earlier. we also have a counseling service that the university can access. We've got a mental health advisory service. we've got good relationships with our health partners, like reps, but obviously there are other GP's or practices that students might be registered with. and we also have staff that have experience from working at Women's Aid and Equation. So, the local charities for people that might be experiencing domestic abuse, specifically. And you know, Women's Aid obviously is for women, as the title says, equation is not only for men. It might also, be appropriate for people who are LGBTQ. Plus, because we know that there is also domestic abuse across across all gender and sexual identity and within within that is a place where all these all these support networks are available. So anywhere where someone can can go, oh is that is that just going through a little bit of, you know, you find these, you find these through the process of going through a support and support process. Yeah. Often people won't not realize these services exist until they need them or until they know someone that has, experienced them. And I know sort of within my safeguarding role, from a health hosting role, I have a number of services that I know exist locally that I can support students to access, if need be, that are external to the university. so it's kind of knowing what the situation is, because there's no two safeguarding situations that are the same because of the nature of the concern or the impact. so I wouldn't expect students to know exactly where to look. a quick Google search is always handy. Or sometimes you might pass, service in Nottingham or see an advert on a, leaflet or a banner or a bus, for something particularly. So it's a tricky one to answer because there are so many different services. It's just knowing which one is relevant for you at that moment. but by conducting, as you say, that report and support, it opens the door, opens the door, and it gives you that sort of grounding to to get that direction rather than trying to go at yourself. Yeah, yeah, yeah. And that's the university is here to help with which is, which is, which is really important. Yeah, absolutely. And I suppose I know this is slightly veering away from the safeguarding, but knowing the type of courses our students do and the, intensity with that. I do think it's really important that outside of lectures, outside of placements, that you do plan regular activities that you enjoy, whether they are with your loved ones, your friends, your family. and it doesn't have to be, you know, fancy holidays. It can be going for a walk in the Peak District. It could be for me. I like to go and seek mediums because they make me laugh and it takes my mind off whatever I'm dealing with. for some people, it's gym ING. For some people, it's baking. Whatever your thing is that restores you, it's really important to plan that in regularly. Hopefully students aren't going to be around it all the time. but that can be times. It can be all consuming and feel like you can't think about anything else. So. Or the way that I kind of keep my I unwind from things is by doing some of those things. I've talked about getting away from screens often. For me, movement is involved by some kind of exercise. I don't always have to break a sweat, but just something that I'm thinking about what's around me, not what has happened that week at work. And I think that that's a really important message. and that that ties actually very well into, patient, patient cath managements rehabilitation. so a lot of our students, I feel listening to this will be involved in these kind of, these kind of fields. And I think this adds a real depth. when we talk about wellbeing, isn't it. it's not just about, getting more movement into a joint, it's actually more about the, the many benefits of exercise. We know physiologically, there can be benefits. muscles can grow, hearts get stronger. you know, various conditions, like, you know, the rate, the risk of diabetes and things like that. I could go down. However, I think what you said about finding something enjoyable, purposeful doesn't mean you've got to, you know, hit the gym, at 100 miles an hour and come out sweating and thinking that was a good workout, as you say, sometimes, just like getting away from blue light, a heavy situation, finding that ability to to have, you know, like an off switch or even just a dampened down switch. yeah, I think it I think it speaks volumes, doesn't it? I think boundaries are really important with with work and taking me wrong. There'll be times for all of us when you are thinking about work, when you're away from work, it might be you're on on your leave, or you're on a weekend or your is on your day off, but you are still thinking about work and it's trying to limit how much of your thinking time it takes. and I know it might seem like a small distraction, but I think that can really help you to unwind, focus on other things, give your attention to things that are filling your cup, things that are making you happy. because it it can feel a bit doom and gloom, unfortunately. but it's, I think, planning those things in regularly, for me at least, it's, it helps me to stay balanced and having friends that are within my field, and also having people that are not in health care at all and having that balance of the conversation, because I know when you're with fellow health care professionals, conversations dwindle back to not patient, specific things, but maybe some of the work politics or shift patterns and things like that. And sometimes you want people that don't have those don't have that to add to the conversation. And you'll talk about current affairs or what was on TV last night. And I think I think that's a really important message. I was saying, previous part with, with Betty piteously when, when I was a student, with, old halls used to be when the school of physio used to be used to Belfast City Hospital, not like UMC. And I mean, I don't, you know, I don't regret the time I had at those hall from my when it was great, I made some great friends, but on reflection it was quite, we were all physios in this place, so it was quite a very physio, kind of, you know, vibe and and a lot of benefit from that. But actually one of the things which helped me a lot was, I was, I was Beth's best man and a wonderful husband. Tim. So me and Tim actually met in the very first week. I got a friend, actually, one of my friends on the physio course knew Tim at their halls, and they just went, oh, I know a guy who's into into guitar and Jamie like drums. Why don't you meet each other? And it was just this chance thing. We met and then all these years later, you know, incredible person. And, but the amount of enjoyment I got from. Yeah, exactly what you said. Look, love physio, love rehab, study a bit, but over time, I just had to come away, go to campus, play some music, play some gigs, do something different. And, you saying before you like comedy and, you know, are there any particular, like, you know, that obviously gives you a lot of pleasure and enjoyment as a particular comedian. She like or any particular sort of shows that you like to watch or anything like that. Where do you start? James? I'm a big fan of Taskmaster and I'm loving that at the moment. It's just it's funny. It's, it is silly and it's not something that I have to kind of focus and concentrate on. compared to like, a thriller or something. So I just find that, you know, my Thursday nights, 9:00, I can laugh, I get a laugh out of it. It's. And yeah, though that for me is something. I know you said about your music for me, I do quite a lot of sport. So at uni, when in my undergrad I played netball and I also took up ultimate frisbee. And again, both of those having the trainings for those sports and like, fixtures and things. yes, balancing around my placements and my, and my theory, I couldn't always go, but I really enjoyed not just the movement and the teamwork, but also the teams that I have. and I've, I'm still really close with some of them. You know, my teammates from uni, one of them was a bridesmaid at my wedding. yeah. And, you know, you you're in that position together. Yes. You're uni, but you're also doing something for you and something that's fun. so yeah, I'd encourage students to whatever your hobby or interested in, find your people at university, find people that are similarly minded, whether they're doing your course or not. because you'll lean on those people at different times. They'll lean on you. but it's important to have connections in things outside of the course. Those things that I've talked about, I've had that can happen to other students. So in practice do not happen on a daily basis. They are not things that you are going to be doing. You know, three times a shift necessarily. There might be some that you have multiple instance doing a shift, but you know, this is not something, that happens that frequently. yeah, I think I think it's brilliant advice. and one thing I would, I would say though, is often when you can look back ourselves, maybe on our university days to maybe where we both are now, a lot of change, right? A lot of our experiences change. Change us. How would you say that? Perhaps the world of work, obviously. What you deal with is incredibly important, but as you say, it's also it can also be quite, challenging, quite heavy. So as a person yourself, and since your personal growth and develop, how do you feel you've perhaps changed over the years by going into this incredibly important field? I think coming into academia particularly, I've matured quite a lot. not to say I was immature beforehand, but I think with the life experience and particularly working as a health system and handling so many different safeguarding cases, has really helped me to refine my work, particularly having to write several different chronologies or statements for coroners court. it's really made me a better practitioner as a result. And, I always echo that to students when I'm supporting them with writing reports, is that they'll come in with some notes that they've made, which is a really good start. I will build on it and probably increase the length 3 or 4 times over, because we're giving all the background information, the context, explaining the roles that people have and who who is there. so I think over, over my career so far, I've definitely kind of my life experience has also enhanced how I handle things. I'm less quick to jump to conclusions and assumptions. and I'm not always questioning why, but I'm trying to. I'm rather than asking people questions that they can answer yes or no. I'm trying to say, oh, can you tell me a bit more about that? Or what does that mean for you? Questions that give somebody time and space to tell me as much or as little as they want, rather than close questions that kind of a student or somebody else could could answer a yes or no. Will one word and leave it there. And I think, showing that attention and kind of wanting to learn more about somebody else makes people feel listened to and valued, and heard. And I, I want my students to know that I'm listening and I'm and I care. And I want to help support them to be the next best version of themselves that's going to contribute to the future workforce. I think open questioning is so important in healthcare, and it takes time to get used to asking those open questions. And also being available to listen to the answer. not not to reply, but to listen to what's been taken on. Yeah, it definitely comes with time and experience, and I'm sure over the placements that our students have, they'll learn from different supervisors, mentors, different members of staff they work with as to how they ask patients for information. Obviously certain things like what's your name? What's your date of birth? They're kind of closed questions, but you might say, tell me what's brought you in today or tell me about your family history. or what does a day to day activity look like for you? And then you're giving that patient time rather than saying, can you put your shoes on, yes or no? Can you wash and dress yourself? Yes or no? And and kind of limiting your chances for your patients to be heard. And again, you'll see how people do it effectively because I'm mindful of time pressure and that you need to get through your assessment. Or you've got a number of patients waiting in the clinic, for example. but there are definitely times to take that extra moment to make sure that patient is heard. Yeah, you're absolutely right there. There is definitely a skill to this. and I there was there was a statistic. so I refer it back to physio, but it was, it was something like the average physio if, if giving someone an opportunity to start telling them about. Oh, and I welcome tell me about your pain. It was something like the average physio took about 60s before they then cut in to either ask that patient another question or two, direct the s in a particular way. And it's a fascinating it's a fascinating piece to say that's where it is. And I don't know how you found out, but I actually find it. I'd like to try and give people that open space to talk, but there are some patients out there that don't like that. Have you found that as well? Yeah, absolutely. There are patients that know that they don't want your input, but they want to reveal as little information to you as possible. And you just have you kind of you might work that out in the first couple of times and meeting them. It's not always that obvious depending on the kind of assessment you're doing. but again, I think if you can build a rapport with someone, and sometimes sharing a little bit person, they say, oh, you know, I don't know, talk about the weather. Classic British thing today. We'll talk about the traffic or something that everyone can relate to. It might be you ask them what they had for breakfast and kind of just see if they'll not soften, but just open up that little bit more, and see kind of which, which route of questioning that takes you down and, and that, you know, some patients will be more open on other sometimes than others. and again, it's working that out through building that, that professional rapport. Yeah. It's spot on. I've funny reminds me of a story I was of saying, I think it was only, only yesterday with, with patients. It's this obviously we often have that name in front of us and you build that build up. And I'm standing one of my and colleagues that strangely enough, I have this, ability to remember quite key bits of information from patients. And if they had perhaps, a dog and their name or if they, if they been on a holiday or something quite random, which I often would use the next time I saw them as best I could be, like, oh, you know, you're watering your piece, Lily. last time you saw me, I was like, I don't know, you remember I a piece like. And it really felt like it really strengthened that rapport. The, the the slightly embarrassing thing was, I'll be all for remembering any patient's name outside of the clinic. And it would happen. I'd be sometimes walking in, the patient would come up and remember my name, which was nice, and I hope I was a good thing and I would. I've been absolute like thinking, I don't know, they John, Jim, Tom, I don't know about the name and but as you write, that rapport is such an important part of patient care, isn't it? And you rightly pulled up the, you know, if there's a something small that the patient might let you in on, like you say, if they have an animal or, a sister or, you know, they're going on holiday or something, those things mean that er, you've listened, but maybe you're asking that maybe before launching into the rest of the, the more health related aspects. And I think patients really value that because they think, oh you, you remembered that. That's what I'm, I was doing at the time or that, that's what I had coming up. And, you know, like I said, it kind of break before you launch into your questioning. I think it can, help patients remind you that you care and that you do remember certain things. You don't have to remember everything. And that's your your whole consultation will be about the holiday. but picking up on 1 or 2 small things can make a huge difference. I think one thing I would also say, it's really evident of how much you care. And, you know, I always remember, you know, you looking after me when I, when I started, I think you saw me looking lost down a corridor. And, you offered to even just say you were and, you know, even just start up that report from that and what you nice about. See, I'm so glad you did. Because, you know, I always enjoy when we, we, we chat and, you know, and we get to know what we're doing and things like that. So I think that care aspect comes across really strongly from yourself and a number of people within, within the school. But from what I'm also hearing you say is that that is obviously very important. But life is also difficult. It's complex. We all are trying to work on that balance, aren't we? Yeah. And I think, you know, we we know that, students don't just want staff. Don't just leave everything at the door when they come in for sessions or lectures or into their offices. At the end of the day, we're all humans. We all have emotions that we're dealing with. We all have things going on in our personal lives that other people know nothing about. And I think it's always that trying to be kind to people where possible, trying to, you know, if if someone isn't having their best day, maybe ask them a little bit, but they may not want you to try too much. And again, until you know someone, better, you kind of can read. You know, the signals that they're giving you. but I think, you know, like we've said, you don't know what other people are dealing with. So be kind and be kind to yourself as well, because sometimes you might go through a rough day and you may not want to do things that you've got planned. and hopefully you can rearrange them or postpone that coffee with a friend. I think that's a really nice way to to bring the pod to a close. But one thing I just the last thing I'd like to ask you, is off. So after NASCAR, I guess if there's any missed one, like strap line of advice from Kat Chang's advice, it could be. It could be a general piece of advice for people to listen to. It could be student specific advice. It could be something that you follow, for yourself. Is there anything there that you think, oh, I want to say this, that people can listen to and and take on a role to play for us to put you right on the spot here and apologize for that. Them. I think for me some it comes down to keeping an open mind because that might be for our students, it might be on their placement area. So just because placement one, maybe it's not been your cup of tea, it doesn't mean that placement two, three, 4 or 5 are going to be the same. and that for me was how I found, you know, the most where I spent most of my clinical career was keeping an open mind when I went for that health listing and people said, oh, it's a doddle. You get sent home early like they don't. You don't have to do anything in the way that you would do on a ward. You kind of sit in people's houses and that's that's what other friends have sold it to me. I so I was like, well, as much as I've said that, I'm going to go in and just see what this health visiting malarkey is all about, because I've not really come across it. and it turned out to be the thing I wanted to do for most of my career. So, you know, I think it's important to keep an open mind, not just for our students, I think. Anyone else listening keep an open mind of what's going on in your life and remembering to maybe take a step back every so often and keep you keep topping your cup up, making sure you're doing your self-care. the world can be so busy and you know, adverts everywhere and everything can be quite consuming. And I think keeping that open mind and knowing when to take a step back or to say no is also important. So it's that boundary kind of keeping as well as, you know, having that open mind, a professional curiosity in that professional sense, but maintaining our wellbeing as well. Probably. Well, so I said, it's been absolute pleasure to have you, on this point today. So thank you ever so much. And, yeah, keep in touch and speak to me. Thanks, James. I've really enjoyed it. You should not have gone away.