Jan. 7, 2025

#135: I Want To, But I Can’t: 3 Ways Moral Injury Differs From Burnout (And Why It Matters). With Dr Shannon Bass

#135: I Want To, But I Can’t: 3 Ways Moral Injury Differs From Burnout (And Why It Matters). With Dr Shannon Bass

In this episode, we delve deep into the concept of moral injury, a profound emotional burden that arises when external constraints prevent professionals from acting in line with their ethical standards.
Starting with real-world examples, we distinguish moral injury from trauma and burnout by spotlighting its unique focus on ethical dissonance. For veterinarians, this might look like the heart-wrenching decisions around economic euthanasia, navigating systemic barriers, or managing client noncompliance—all scenarios that leave professionals feeling conflicted and powerless.
Here’s what you’ll gain:
Clarity: Understand how moral injury differs from burnout and compassion fatigue, and why this distinction matters.
Strategies: Discover actionable steps to address moral injury, including fostering open communication, building supportive communities, and implementing targeted interventions.
Empathy and Connection: Learn how vulnerability and shared experiences can help mitigate the long-term effects on veterinary professionals.
Whether you're a veterinary professional or someone supporting them, this episode is a powerful exploration of how understanding and addressing moral injury can create a healthier, more resilient veterinary community.

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Season 1

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Do you ever feel just... flat? Not inspired, not excited, and certainly not energised. It might feel like burnout. Or is it compassion fatigue? Maybe it's neither.

You know those moments in veterinary medicine when you know the right thing to do, but external circumstances prevent you from doing it? That dissonance, that discomfort deep in your core: that’s moral injury.

In this episode, we unravel the complexities of moral injury with Dr. Shannon Bass, a leader in veterinary medicine and a passionate advocate for supporting veterinarians through the psychological challenges they face. Moral injury, often confused with burnout or compassion fatigue, is an under-discussed but critical issue in our profession. Together with Dr. Bass, we explore the distinctions between these terms, their impact on veterinary professionals, and how to address them effectively.

Dr. Bass brings over 20 years of experience in general practice, emergency veterinary medicine, and leadership to this conversation, where you’ll learn

    • How moral injury manifests in daily practice
    • The importance of differentiating it from burnout and compassion fatigue
    • Why 'client bashing' can be a symptom of moral distress, and
    • Practical steps to create healthier and more supportive veterinary work environments.

 

Topics and Time Stamps

  1. Defining Moral Injury - 02:58

  2. Differentiating Trauma, Moral Injury, and Burnout - 07:04

  3. Moral Injury in Veterinary Practice: Subtle and Irresolvable Cases - 10:03

  4. What’s New for the Vet Vault in 2025 - 16:33

  5. Moral Injury vs Moral Distress - 21:18

  6. Moral Injury vs Compassion Fatigue - 24:01

  7. How Does Moral Injury Manifest? - 27:01

  8. How to Address Moral Injury: Recognising and Implementing Solutions - 29:44

  9. The Role of Vulnerability and Shared Experiences - 33:25

  10. Communication, Community, and Support - 38:59

  11. Shannon’s Podcast Choices - 46:29

  12. Pass-Along Question - 49:30

 

Get in Touch

Email us at info@thevetvault.com if you want to find out more about Vet Vault/Vets on Tour 2025 in Wanaka, NZ, or about the Essential Consequence Management series for practice leaders with Rhonda Andrews.

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“What is Moral Injury? Understanding the Hidden Stress in Veterinary Medicine”

Defining Moral Injury in Veterinary Practice
Moral injury is the emotional and psychological distress that occurs when someone is unable to act according to their ethical or moral beliefs due to external constraints. In veterinary medicine, these constraints often arise from systemic barriers, financial limitations, or decisions imposed by clients, colleagues, or leadership. Unlike burnout or compassion fatigue, moral injury involves a deep sense of betrayal of one’s core values, leaving lasting emotional scars.

The concept of moral injury was first articulated in the military context by Dr. Jonathan Shay, an MD psychiatrist, who defined it as the psychological consequence of a betrayal of what is right by someone in a position of legitimate authority during a high-stakes situation. This betrayal factor is a critical component that differentiates moral injury from other stress-related conditions.

The Core Elements of Moral Injury

  1. Ethical Betrayal: Feeling unable to uphold personal or professional values due to external factors.
  2. High-Stakes Situations: Often arises in critical or emotionally charged scenarios, such as euthanizing savable animals.
  3. Lasting Emotional Impact: Leaves a lasting sense of guilt, shame, or anger that can affect mental health and professional satisfaction.

Real-World Examples in Veterinary Medicine
Moral injury in veterinary medicine is not confined to extreme or rare cases; it manifests in everyday practice through situations like:

  • Economic Euthanasia: Being forced to euthanize an animal because the client cannot afford treatment, even when viable medical options exist.
  • Noncompliance from Clients: Sending a critically ill pet home against medical advice because the owner refuses hospitalization, often out of misguided attachment or misunderstanding.
  • Animal Abuse or Neglect: Witnessing cases of abuse or neglect and being unable to intervene effectively, such as when a neglected animal is returned to the same abusive environment due to legal constraints.
  • Systemic Constraints: Feeling powerless due to corporate policies or economic pressures that prevent delivering the best care, such as restrictive referral guidelines or inadequate staffing.
  • Mass Depopulation Events: Participating in large-scale euthanasia during disease outbreaks, like foot-and-mouth disease, which leaves lasting emotional and moral scars.

How Moral Injury Differs from Burnout and Compassion Fatigue
While moral injury shares overlapping symptoms with burnout and compassion fatigue, it is distinct in its origins and emotional consequences:

  • Burnout is characterized by exhaustion, reduced productivity, and feelings of being overwhelmed due to prolonged stress. Rest and workload adjustments often help alleviate it.
  • Compassion Fatigue arises from the emotional toll of empathizing with clients and animals in distress, leading to emotional exhaustion.
  • Moral Injury stems from ethical conflicts where veterinarians are unable to align their actions with their values, leaving a profound sense of betrayal and guilt that rest alone cannot resolve.

 

Symptoms of Moral Injury
Moral injury often presents with psychological and behavioral symptoms, including:

  • Guilt and shame about past decisions.
  • Depression, anger, or emotional withdrawal.
  • Reluctance to share difficult experiences due to fear of judgment.
  • Isolation and a growing sense of professional dissatisfaction.
  • Dreading work or experiencing recurring intrusive thoughts about unresolved cases.

Addressing Moral Injury in Veterinary Medicine
Moral injury is a pervasive issue that requires intentional strategies to address its root causes and mitigate its effects on veterinary professionals.

  1. Awareness and Education:
    • Educate veterinary teams about moral injury and its distinct characteristics.
    • Provide resources and training to recognize the signs of moral injury in themselves and others.
  2. Fostering Open Communication:
    • Create safe spaces for team members to discuss emotionally challenging cases.
    • Promote vulnerability and emotional sharing among staff to reduce feelings of isolation.
  3. Building Peer Support Systems:
    • Establish small peer groups for discussing moral injury and other stressors in practice.
    • Encourage participation in professional organizations like the Veterinary Hope Foundation, which offers structured programs for veterinarians to share their experiences.
  4. Addressing Systemic Issues:
    • Advocate for better staffing, realistic scheduling, and supportive policies that allow veterinarians to practice in alignment with their values.
    • Train practice leaders to recognize the signs of moral injury and take proactive steps to reduce its prevalence.
  5. Promoting Emotional Resilience:
    • Encourage mindfulness practices and resilience training tailored for veterinary professionals.
    • Offer access to counseling services or veterinary-specific mental health resources.
  6. Recognizing the Role of Leadership:
    • Empower leaders to model empathetic communication and decision-making.
    • Equip management with tools to address systemic issues contributing to moral injury, such as overwork or financial pressures.

The Importance of Recognizing Moral Injury
By acknowledging moral injury and distinguishing it from other stress-related conditions, the veterinary profession can take steps to mitigate its impact. Understanding the hidden stress of moral injury is not just about improving individual well-being; it’s also about fostering a healthier, more sustainable practice environment. Recognizing and addressing moral injury allows veterinarians to align their professional actions with their ethical values, leading to greater satisfaction, reduced emotional burden, and improved patient care.

 

“5 Common Causes of Moral Injury in Veterinary Medicine”

Moral injury is a pervasive and often misunderstood issue in veterinary medicine, stemming from situations where veterinarians and their teams are forced to act in ways that conflict with their ethical values. Below are five common causes of moral injury in veterinary practice, highlighting the systemic and situational pressures that contribute to this hidden stress.

  1. Economic Euthanasia

One of the most emotionally challenging aspects of veterinary medicine is euthanizing animals due to financial constraints rather than medical necessity.

  • What it Looks Like: A pet with a treatable condition is euthanized because the owner cannot afford care.
  • Impact: Veterinarians feel a profound sense of guilt and helplessness, knowing they have the skills and knowledge to save the animal but are prevented by financial barriers.
  • Example: A young, healthy animal is euthanized because its owner cannot afford a relatively simple surgical procedure.
  1. Client Noncompliance or Misguided Decisions

Veterinarians often encounter clients who refuse recommended treatment plans, even when cost is not an issue.

  • What it Looks Like: Owners decline hospitalization or life-saving treatments due to personal beliefs, attachment issues, or misinformation.
  • Impact: This creates moral distress as veterinarians watch animals suffer unnecessarily while feeling powerless to intervene.
  • Example: A client refuses to leave their pet with severe respiratory distress in the hospital, insisting the pet "can’t be without them," despite medical advice.
  1. Systemic Constraints in Veterinary Practices

Corporate policies, inadequate staffing, and time pressures often limit veterinarians’ ability to provide optimal care.

  • What it Looks Like: Practitioners are forced to prioritize tasks, resulting in less time or resources for critically ill patients.
  • Impact: These constraints lead to feelings of inadequacy, guilt, and frustration, especially when decisions are influenced by business models rather than patient care.
  • Example: A clinic denies hiring additional ICU staff despite repeated requests, leaving the existing team overwhelmed and unable to meet the standard of care.
  1. Encountering Animal Abuse or Neglect

Witnessing cases of abuse or neglect is an all-too-common experience for veterinarians.

  • What it Looks Like: A neglected animal is brought in for treatment, but the veterinarian is unable to ensure its safety after discharge.
  • Impact: Veterinarians feel morally compromised when they must return the animal to an abusive or neglectful owner due to legal constraints.
  • Example: An animal shows clear signs of abuse, but legal or procedural barriers prevent the veterinarian from intervening.
  1. Depopulation of Livestock During Disease Outbreaks

Large-scale culling of animals, while sometimes necessary for public health or disease control, is a significant source of moral injury for veterinarians.

  • What it Looks Like: Veterinarians are tasked with euthanizing hundreds or thousands of healthy animals during outbreaks of diseases like foot-and-mouth or avian influenza.
  • Impact: These events leave lasting emotional scars, as veterinarians struggle with the conflict between their professional duties and their values.
  • Example: During a disease outbreak, a veterinarian spends days euthanizing animals, knowing it is devastating to the animals, the farmers, and themselves.

Addressing the Causes of Moral Injury

Recognizing these common causes is the first step in addressing moral injury within veterinary medicine. By fostering open communication, advocating for systemic changes, and building peer support networks, the profession can work toward mitigating the emotional toll of these situations. Addressing moral injury not only improves the well-being of veterinary professionals but also enhances the quality of care provided to their patients.

It is the start of a brand new year.Maybe you've had a good break and you're feeling refreshed and ready for the year ahead.But maybe you're not.Maybe you're coming off the rush for the festive season and you saved many lives and provided comfort to hundreds of animals and you did great things.
But there's that one case that sticks in your mind like a soup bone that gets stuck in a dog's esophagus right there above the heart.It's the case where you could have made a difference.You wanted to help.But something outside of your control made you do something that made you feel a bit yuck deep inside the part of you that hasn't quite hardened up yet.
And now, as you're coming down from that buzz of the adrenaline that keeps you going through any busy spell, you're feeling a bit meh.A bit flat.Maybe you're just tired.Maybe you think that you're a bit burnt out.But maybe you're not.Maybe there's more to it.And that's why I think.
Talking about the term moral injury and educating people about how it's different than burnout or compassion fatigue is so important because I think so many veterinarians really have moral injury issues.But they say I'm burned out or they say I have compassion fatigue.
But they are three different things that we can have all at the same time sometimes, but they do have different ways that we want to approach trying to make them better.I'm Hubert Thinsman.You are listening to The Vent Vault, when we occasionally stick an endoscope down your emotional esophagus to see if we can figure out what exactly is stuck there, jabbing its Bony little spines into your heart.
And in this episode, we are exploring the phenomenon of moral injury.You've probably heard of the term, but if you're like me, you don't know exactly what it is.Or maybe you hear the term and you think, yeah, that sounds like me.Tell me more.Well, in this conversation, you will learn exactly what it is, how it's different to burn out and compassion fatigue and trauma, why it matters to differentiate those things and what you can do about it.
Our guest is Doctor Shannon Bass.Shannon is the vice President of Medical Leadership at Vets Beds, a collaborative network of veteran hospitals in North Carolina in the US, where she is all about mentoring hospital leaders and advancing veteran care.With over 20 years of expertise in both general practice and an emergency medicine, she brings a wealth of knowledge and empathy for the challenges that we face as vets.
And she really walks the walk.And in this episode, Sharon and I will define moralist stress and moral injury, unpack the psychological impact that it can have on you, and discuss the systemic challenges in our profession, from financial constraints to time pressures, and how these put us in the path of moral injury.
And most importantly, of course, we will share actionable strategies to recognize, address and mitigate these issues so that you can keep doing what you do best and help those around you to do the same.OK, let's get into it.So we want to talk about moral injury, which has actually been on my radar for a a long time.
It's something that I'm.Not 100% clear on what it is, and we'll come to definitions and stuff in a second, but I've heard the term and I've heard a vague explanation and something in my head goes, Oh yeah, yeah, I recognize that.I, I, I've felt that.I'm pretty sure I have.But before we get scientific and get into official definitions and stuff, what about examples?
Is that an easy way to introduce the concept of give me an example of what moral injury is and then we'll backtrack and unpack it a little bit more?I think examples are the best way to start talking about it.And then I actually have two that I'd like to run through.And they're, they're both really extreme.
But I think using an extreme example is one of the best ways to make it obvious.So the first would be in 2025, in August of 20, not 2025, August of 2005, after Hurricane Katrina hit the Gulf Coast Memorial Hospital in New Orleans.
Their basement flooded and their basement was where all their generators were, their water systems were.And so they lost water, they lost power to multi story big public hospital in New Orleans that was a place of shelter.
So patients, families were there sheltering with the patients.People were there that had nothing to do with the hospital.They were just in the lobby on the ground floor because it was known to be a very safe place during hurricane in New Orleans.So there's a huge amount of people in this hospital that now was an island surrounded by water with no power, no electricity, limited supplies for all these people that were in the hospital.
And so for five days they were just there by themselves and they ran out of everything.They were unable to appropriately care for their patients, and so the staff had to make some horrible decisions about who to evacuate via the limited helicopter evacuations that were available.
And that was really hard because, again, there's no elevators.So if you're on the 5th floor of the hospital and you're a sick patient that's critical enough that needs to be evacuated somehow, they have to get you down.The helipad was on the roof of the adjacent parking garage.
They had to get you over to the parking garage, get you back up to the roof of the parking garage to get you on the the very few helicopters that were available.So who goes out as supplies ran out?Who got the limited supplies and who did they stop caring for?
Because you too sick and, you know, wow, that's yeah.And so patients died.And there are multiple first person accounts about how overwhelmed the staff was with having to make these choices where they knew what the right thing was, which would be to care for everyone, but they were unable to do the right thing.
So that is massive moral injury.The staff felt very let down by authorities at all levels, federal, state.The corporation that owned the hospital, local hospital leaders that had to make decisions that not everyone agreed with.
And so those staff members walked away from that experience with massive moral injury about knowing what was the right thing to do but not being able to do that.The other kind of unexpected crossover to veterinary medicine is some of the staff were sheltering there with their pet and then Katrina.
People were not allowed to take their pets when they were evacuated, and so staff either had to leave their pets in the hospital or some staff elected to euthanize their pets prior to getting evacuated at the end.
So I mean, just really rough, yeah.So this is where I get fuzzy about definitions because I listen to that and I go, Yep, OK, that's traumatic.And we hear about trauma and micro traumas and things when we talk about Wellness and psychology a lot.
So that that different.Let's differentiate that first trauma or micro traumas.That's not a micro trauma, that's a massive trauma and moral injury.Is there a difference?Does it matter?I do think it matters.So Dr. Jonathan Shea is an MD psychiatrist who was one of the first people to start talking about moral injury, and he was doing it in the context of of military experiences.
So the definition that he has written is the moral injury is the psychological consequence of a betrayal of what's right by someone who holds legitimate authority in a high stakes situation with betrayal.
Of what's right being a really key term that separates it from trauma.So when you think about this Memorial Hospital example, the betrayal of what's right is that these people, through the decisions of a whole bunch of other folks, right, that had legitimate authority, federal authority, state authorities, corporate authorities that owned the hospital, There were some people that made decisions.
That caused this moral injury and that's different than the trauma of let's call it a car accident or a multi car accident or some kind of natural disaster.That's trauma, but no one made a decision.Gotcha.All right.So in that the hospital scenario on a normal day in a in a hospital, the traumatic event might be seeing the consequence of somebody drowning in the flood or you know, kid comes in who's.
Badly injured from a car crash and that yes, there's an emotional reaction.Whereas with the moral injury, you actually have a part in the bad thing that's happening, but due to situation that's out of your control.So I, I know what I should do.
My values say do this thing, but I can't.My hands are tied and then there's an emotional consequence to that.Does that make sense?OK.And do they have different outcomes psychologically?Like the repercussions of the two, are they are they differentiated?
They do because we struggle in the moral injury with then what what decision did we make and did we make the right one as a result of something that we were thrust into unwittingly versus the car accident scenario or you know treating a patient that's critically I'll most of the time if.
Even in the veterinary space, if I'm treating a critically, I'll pet and it doesn't make it.Most of the time I don't feel like that's my fault, right?That's because the pet came in very sick and there weren't enough things to do that would save it.Yes.OK, So why did you start caring about this topic?
Why did you read up about it and why did you want to talk about it?I accidentally stumbled on a book that's called If I Betray These Words by Doctor Wendy Dean, who's also a human physician.And her book is about the struggles of human physicians who were prevented from providing the care they wanted to provide because of the system in which they worked.
And so she is talking about insurance companies.This is on the human medical side in the United States, where insurance companies might say, no, you can't have that surgery or you can't get that test.Or even in large corporate medical groups where there are very strict referral rules that I can only refer to this group, but I know perhaps it's the human physician that that's not the best group for my patient, but I'm unable to send them to the best provider because of these strict rules.
And so she talked about how that's such a huge struggle for human physicians when they're prevented from doing the right thing.And I really identified with that because I think veterinarians are faced with similar decisions via different routes, but similar decisions that we can't control.
And I was like, wow, so she's talking about moral injury on the human side, but I think this is happening on the veterinary side.So let me figure out what moral injury is.And then how does that apply to veterinarians?Because if we don't know what it is, then we can't address it appropriately.
Absolutely.So from what we've discussed so far, I, I'm starting to get some clues of how it applies to us in, in veterinary science.I mean the, the obvious 1 you talked about people having to euthanize their pets in the hurricane.Well, we do that.
I wouldn't say all the time, but more than you'd like where things are euthanized, where I have the knowledge and the, the skills and the power to prevent that, but.Some factor is making the euthanasia a savable animal.So to me that's the obvious 1.Does that, does that fit?
That fits right?That definitely fits and and like you said, we're not talking about the euthanasias of the 14 year old Labrador that you know, it has lived an amazing life and right because.You're doing, you're doing the right thing and that's, well, at least that for most of us that aligns with our values and corn leaves.
But there's others where there's lovely Staffy.As nipped at a child and and and you know it's not it's not the dog's fault and now you have to euthanize it or obviously the big thing.Yeah, money money's probably a a big reason why.We money is a huge injury Yeah, or even and on the euthanasia front, even I've been asked to euthanize pets cause the owner's moving to an apartment that won't accept their cat, right And then on the non small animal side, depopulation.
Of herds or flocks because of infectious disease, right?Like that's a moral injury for the veterinarians that are involved in that.And, and typically when they're doing that, that it's day after day after day of sometimes really massive depopulation.Oh yeah, when I was a finally a vet student, the guys that here ahead of me, it was the foot and mouth outbreak in the UK and all of our, all the friends, you know, just great money, they were all going there enthusiastically employed by the UK government.
To work on foot and mouth.And what most of them did all day was euthanize people's livelihood.The herds of cows, and a lot of them are seriously, seriously affected by having to do that.Absolutely.So those are the obvious ones.Are there things that you, having thought about this for a while and digging into it, are they most subtle, more insidious incidents of moral injury that we probably experienced in red signs but might not recognize?
Absolutely.There are so many honestly suspected animal abuse and neglect I think is a big part of it.That and those are some of the cases that that really stick with me over time of an animal that is presented by the person that has abused or neglected it.
And sometimes those people refuse the appropriate care and you have to send that animal back home with that same person.That brought it in and I I want to do better treatment for that pet.I want the person that brought it in to have some consequence for what was done.
But I am unable for a variety of reasons and all the different scenarios that this encompasses, I'm unable to actually do that.And so I just watch that pet leave and that is moral injury.It's owner non compliance with recommendation and this has nothing to do with cost for me is a largely an emergency veterinarian.
This was the owner that wouldn't leave their respiratory distress pet in the hospital because they felt like the pet couldn't be without them.How many times have we heard that?And so I'm sending this labored breathing animal out of the hospital like that's not right.
I know that's not right.And I want to put that animal in oxygen and give it appropriate medications.And the owner is refusing to do that.And that has nothing to even do with money, right?That's just their misguided sense of attachment to that pet owners that.And this is often about money, but the phrase that we've all heard, all you care about is money.
You don't care about my pet.You just want to watch it suffer and die.So in that situation, if we take the definition of knowing what's right, but not being able to do what's right, so I know what's right.The owner is not letting me do what's right, and then they take it a step further and they accuse us of being the bad people in the situation.
Which I think there isn't that lines things so much is because it is a on the one that's so untrue because it's absolutely not true.But on the flip side.Because of the.Scenario that we work in the business model, it's a private business, it is kind of true.
I think that's why it hurts extra because you're like, yes, I this is exactly how I feel and now you're underlining it.And it is, I can't do the right thing because of money.So you're spot on.But it's not me, it's not my values it I'm not aligned with, it's just, it's the system I'm in and and we understand logically why the money is important, but I really do want to just help you.
Yes, exactly.OK, mid roll interruption for some New Year's updates.I am busy mapping out 2025 for the Vet Vault, and I'd love to share with you what's been crystallizing for me around what we do here and how we do it.So what do we do?
Well, we help you find ways to have a happy, fulfilled, useful career and life where you make the most of your degree and your natural potential.Why do we do this?Because you're talented and smart and the world needs more of that.And I hate waste, especially wasted potential.
And you do important work.But As for the how we're going to achieve this, I have come to realize that there are four ways how the Vet Vault can achieve this.Let's call it the four pillars of what we do here.Number one, education and information like this podcast or our clinical podcasts, conferences, and hopefully some more structured courses coming to you in 2025 #2 resources so like our library of searchable show notes and our expanding set of AI tools that help you access the right information when you really need it fast. #3 support like our specialist support space where you can ask our team of specialists for K support, plus other collaborations for non clinical support like the Essential Consequence Management online series for team leaders that I will be hosting with Rhonda Andrews later this year.
And then #4 community like our Vet Vault network, which I'd love to grow this year.And also in person conferences like the first ever combined Vet Vault Vets on Tour conference, which is happening in New Zealand from 10 to 15 August.So those are a couple of the ways that we can support you right now.
But now that we have the road map, actually it's not a road map, it's more of a compass.We can build.On those four pillars to add more and more stuff that'll add value to your veteran career, and we would love you to be a part of it.Links to all of those things are in the show description, on your podcast player, wherever you're listening now and of course at vivafl.com.
OK, back to Shannon.So when you when you think about all these things.It hurts to open your eyes to how many experiences veterinary staff, both veterinarians, technicians, receptionists that get yelled at, how many times veterinary staff is exposed to.
These are not moral injury events that are in on the level of perhaps the Hurricane Katrina example.They're not that extreme, but they're happening every single day.Yeah.And it it's cumulative as well like you mentioned.Yes.So just to be clear on the one factor.
So when we discuss the definition, it's, it's always you can't do what you want to do because of some external bad guy.So I'm trying to identify the common stumbling blocks, the the roadblocks for us and, and, and retro science.
So it'll be so we said clients decline decisions or client thinking or attitude.Money's a big one.And, and I've touched on it before, the systems that we operate in.So it's the boss.And again, it's not because the boss is a bad guy, but there's are the realities of veterinary practice.
It is a, it's a business that has to generate a profit.And the other thing that we, you know, we haven't mentioned as well time, because you talk about not providing the care that you want.And I've certainly been in instances where things go wrong and, you know, if you have a patient die who's in ICU or something and.
There's a lot of guilt because you go, oh, I did not spend enough time with that patient.I, I wonder if I could have prevented this if I wasn't running around like a headless chicken with dead consults an hour.Or, you know, it's those nights where everything is crazy and then I see he's really busy.And you know that your level of care per individual patient is not where you wanted to be.
And it's, again, it's nobody's fault really.But you sure feel the guilt.I've seen, I've seen nurses.Get hit really hard by scenarios like that where they feel, yeah, I, I didn't do what I was supposed to do.Yes, and I, I absolutely think especially if that is truly you're short staffed, you know, and, and maybe it would get closer, I think to the definition of moral injury if maybe hospital leadership said, no, we're not going to hire you that extra ICU nurse that you've been asking for for six months.
You're going to have to make do with what you have, right.So that is you're in a situation that you knew you needed an extra ICU nurse, you were told you couldn't have them.You know, I think if it's a particular nurse called out tonight because their child was sick and you're short staffed, I think that's a little harder to say.
Are we fitting into the definition?Because you're not really being betrayed by someone, right?You were just if the nurse called out until you were short staffed and a patient died.Those are bad circumstances.But I don't know that that rises to a moral injury.Does that make sense?Yep, Yep.
The other term I've come across is moral distress.Is that the same thing?Moral distress versus moral injury?Same.So interestingly there are some folks in the moral injury conversation that really feel that the the term moral injury should be reserved for military experiences.
And so some of those people have suggested moral distress as a similar term that might be applied to non military environments.And moral injury really did originate in the military space about people that were given orders that they disagreed with, but they had to go out and fight battles with those types of consequences, and they didn't agree to do that.
And so there are people that argue that moral injury only applies in those environments.There are just as many people who argue that one group, can't you?Can.Claim a psychological condition so so I think you know some folks would say there's a continuum of something that might cause moral distress that isn't quite rising to moral injury so I think those those terms are I I don't use them synonymously I kind of use moral distress actually one of the things that I have thought about as moral distress as I hadn't experienced personally one time where I was going to work and this was when my children were quite small and one of them said can't someone else take care of the animals today and and that you know sometimes we call that mom guilt.
I also think there's some moral distress there about I'm the only one on shift, like the right thing to do is for me to go work right.But my child is is also asking in a a way that just really tugs at my heartstrings.That's not moral injury, I don't think.
But there's some distress about like, what's the right thing to do here?Yeah, sure.I never thought of that one as well, but that's A and that's a very common scenario.We certainly went through that as well as parents.So it feels to me like I'm, I'm developing a picture in my head.
It's I want to be here.My soul wants to be here.But something's dragging it over there.And it creates that tension.Yeah.And it just puts, you put your morals under stress, under tension, right?And at some point it it can snap almost.Well, and I think if your day starts like that, right, with your child saying can't someone else take care of the animals today?
And then you get there and that owner tells you that all you want to do is watch animal suffer and die.And then someone else tells you that they're not going to leave their laboured breathing pad in the hospital.That's where I think this becomes very cumulative.It's interesting.I don't know if it applies, but I'm, I'm reminded of a conversation I had a some time ago about compassion and empathy.
So talk people talk about compassion fatigue and there's a theory that says it's not actually compassion fatigue, it's empathy fatigue.I, I feel too much and I, I got down a bit of a rabbit hole on that topic and I'm trying to remember the.So compassion, seeing a problem or seeing pain and being driven to want to fix it.
That's compassion.And then actually acting and doing something about it.And that's a really positive emotion.But then anything that prevents you from doing that.So you feel compassion.I want to act and that positive emotion then switches to a negative again because I, it becomes empathy fatigue, empathy burnout almost where I have the desire to help and I can't because of X.
And they've proven this on with studies with, with brain scans that it shifts literally those emotions shift from a place of positivity in your brain to feel good areas to really where you have that I feel, I start feeling the pain that the patient that I want to help is feeling.
I feel like there there's a different overlap there with that. 100% And that's why I think talking about the term moral injury and educating people about how it's different than burnout or compassion fatigue is so important because I think so many veterinarians really have moral injury issues.
But they say I'm burned out or they say I have compassion fatigue.But they are three different things that we can have all at the same time sometimes or we might have two of them, but they do have different ways that we want to approach trying to make them better.
And so if we don't know that moral injury is an issue, and if I say, OK, I'm burned out, right?Which is defined as a state of emotional, mental, and often physical exhaustion brought on by prolonged or repeated stress, right?So that's burnout.So if I'm burned out, I probably need to change my schedule.
I need to figure out how to rest.How do I give myself some more time because I have this fatigue and exhaustion because of prolonged stress.So if I just rest and change my schedule, but I'm also suffering from moral injury, there's no amount of rest in changing my schedule that's going to help me deal with my moral injury issues.
OK, that makes sense because I often wonder, yeah, there's all these terms, but why?Why do we have to differentiate so carefully?But that makes a lot of sense before we get into what do we do about moral injury?How does it manifest?What are the clinical signs of somebody who's like, because I feel like, OK, when this happens occasionally you have an inherent resilience where you go, yeah, that sucked up and then you come home and you get through it in the next day.
It's a fresh day.If it if it doesn't happen for a while, it's not an issue.But if it becomes an issue, what does it look like?And I think that's the hard part is that it looks a lot like, I mean, a lot of these have very overlapping symptoms, right?That depression, anger, withdrawal, dreading going to work is, is pretty common.
Not wanting to share with other people and, and moral injury is really specific about that.You have stories probably.And I have stories that I don't share with very many people because if I told some of my horrible stories to just a random person that I end up sitting next to on an airplane, they would be horrified, right?
And so then you withdraw and so you stop.If you have enough moral injury and it's significant enough, then you stop sharing because you're not really sure what you can share and what you can't and how people are going to react.And so then, you know, we end up in this place where we're isolated and we're not connected with others.
And that's where really bad things like suicidal ideation and things like that can start, because we, our brains, start to tell us that we're the only ones that feel this way.I you sent me an article, like a proper research article on moral injury, what caught my eye was was PTSD.
It's quite closely tied with this.Is that correct?Did I?Did I get that?It is the difference being the betrayal piece, right?Because PTSD.I'll just keep using the car accident example.A lot of people have PTSD after a really significant car accident where they would relive those moments and it would bother them and it would be hard to get over.
But if you're in a really bad car accident, that is, that is a traumatic experience.But no one had that betrayal piece where they made a decision that really affected you.And even if, let's say you were hit by a drunk driver, you can be really angry at that person.
They made a bad decision, but they there wasn't a like a systematic or systemic betrayal that happened.Systemic betrayal that kind of forced you to betray yourself in a way.Betray yourself right, because you were just driving down the road and the drunk driver ran into you right And so you didn't make a decision there that you are.
You might question should I have looked left sooner?Right.But that's that's a different.Thing this is some, it's a heavy topic because the when you highlight the details like that, you I do go, OK, well, this is actually really common and and a little bit concerning and a little bit of a downer to go, well, this is kind of baked into what we do and we're not the only profession.
So what do we do about it?Can we, can we fix it?Can we make it better?I think that we can, and I think the biggest thing is, is really to understand we can't stop it because I can't control other people.I can't control all these decisions that clients make or that maybe even my hospital leadership makes or, or things like that, that are going to cause me to have to be exposed to it.
But I do need to know that it exists and I need to know that it's different than burnout and it's different than compassion fatigue.And so those are the most important things because our brains naturally, we want things to fit into a paradigm, right?And so if we don't know that moral injury is a thing, then we're kind of doing a square peg and a round hole exercise of trying to say, this is how I feel.
And if I incorrectly name it as burnout.And so I change my schedule and I go part time and I rest and I meditate and I'm not feeling better then I'm lost.And so knowing that moral injury exists is a huge first step in order to be able to to make a plan.
Then the two people that have done the most research on this, Jonathan Shea, who I mentioned earlier, he's AMD psychiatrist and doctor Brett Litz is a psychologist that's really active with the Veterans Administration.Both of them agree that the best treatment for moral injury is to be in community and talk about it, and that we have to do that with people that understand.
So it would be a group of veterinary staff, a place where I can share those stories that I am so reluctant to share, and a place where they understand and they're not going to think that I'm a bad person because of the decisions that I made and that they can be in community with me.
And people really agree that that's the biggest and most effective treatment for moral injury.Which is it?It's betwisted that the thing we have to do is the thing that we feel like not doing because of what's happening to us.So you feel because you feel you talk about guilt or betrayal, you feel self betrayed and and and there's a lot of guilt associated with that.
And often I, I think because you feel a bit sick about it, you go, I don't really want to relive that and I don't really want to tell people about it because I feel yuck about it in myself.So people are going to judge me and think I'm a bad what you did what?And as you say, a general member of the public or a friend, you tell them that and they, they either brush it off as Oh, it's not, they don't really get it, or they think you're a widow or a. 100%, yeah.
The other thing that we do really commonly as a defence mechanism is we bash the client.So instead of thinking about my feelings about that respiratory distress dog that was taken away from the hospital, I just stand in the treatment area and I bash the client that took their pet away.
And that makes me feel better in the moment, right?But what I just did is put a bunch of negativity out to the entire team, and I didn't actually address how I felt about that.So you're lashing out, really.
You, you, you've identified the cause of your emotional turmoil and then you bag it, but it doesn't actually fix anything.Actually, it makes things worse because you're right, that is a very quick way to ruin the mood and event and it gives some good old client bashing.Then before you know it, everybody's negative.
We do it all the time and it's a very, it's an easy defense mechanism to jump into, but it's not helping at all.And so in reality, the more healthy response even in that moment would be to turn around to my team and say, that makes me so sad.
And I feel so ineffective because I was not able to convince her that she needed to leave that pet here.And all I can sit here and think about is that that dog can't breathe.And to have my technician say to me, I feel exactly the same way.
Thank you so much for saying that.And then we have that moment where we all acknowledge how bad that felt, but we also acknowledge that we didn't do anything wrong.It's vulnerability in the moment and beyond to be able to be vulnerable with what you're going through, what's happening, and then also how you feeling about it is it just does that.
I wonder how that works.It's just just at least clearing the slate, a little bit of offloading it so it doesn't just become the baggage that weighs you down.And I think if we got good at doing that in the moment, we really would unload some of that baggage and we would give that gift to all of those people around us who would jump so quickly onto that bandwagon of, yeah, that was hard.
And that would be a much more lasting positive emotion rather than Can you believe that woman?And she's so stupid and and many of the things that we more routinely say.People suck.I hear that people suck all the time.And then so here's a is a question.
Do you know, is there any data or any of the research that shows that rationalizing things can help?Because in that scenario, the the client that makes a decision that I don't agree with or the client that has done something that's led to a consequence that makes me angry.
And then I I will feel that the desire to bash and to get angry.But what I found over the years is if I stop and rationalize it and try and apply a little bit of empathy to the client.And it's not that I don't feel for them, but at least I could what, what they call cognitive empathy, where I can put myself in their shoes and go, OK, I'm so angry or so sad or so upset about the situation, but the client's only human.
I get it.They don't have money.They, you know, I don't understand the situation.So I don't know what's led to their bad decision making, but I'm, I'm sure that they're trying to do the best that they can do.I feel like that sometimes lowers the tone of the emotion on, on my side.
Is there anything that that shows that that helps?I can't say about the research.That's not something that I have looked into.So that may be out there.But I I agree with your assessment that assuming positive intent is incredibly powerful, and assuming that this woman has no interest in making her dog suffer, she just has, for whatever reason, her own blindness to the situation that I can't control.
And I find verbalizing the rational reasons why the situation is so shit helps me as well.So let's say there's a it said it's money or it's a managerial decision or something.And then again, that emotion comes up.If I then stop and sometimes verbalize to somebody else, it's some of my colleagues really upset about something to say is yeah, but understand that This is why it has to be this way.
It sucks, but there's no, there's again, there's no malice implied by anything.I do feel like if if I can find a reasonable explanation in my head for why it has to be that way, it again lowers the the tone for me of the.Well, I do think it helps to differentiate things that are just unfortunate circumstances, right?
Like the technician that called out because their child was sick and and there was a consequence like that's an unfortunate circumstance that harm maybe occurred, but no one really did anything wrong.It was an unfortunate circumstance versus someone that is intentionally OK.
Gotcha.You know, doing things.When there's no rational explanation where you go right, this is just stupidity or as you say, it's management trying to be greedy.Or you know, the the kind with the fancy BMW outside who says I can't afford right there in section and I have to use.
That's harder, Yeah.That's, that's harder When you feel like somebody, there's a, there's an unspoken agreement that we have here and you're betraying it.OK, So it's the trail of trust is a key factor.Yeah, you're right.When I think about that, that makes a lot more sense.
So Shannon, for you guys, when you are the helper and the fixer for vets in 30 something clinics, how do you implement what you know where you work because we beyond educating.So saying all right, you guys need to talk to each other.
You need to offload these emotions, otherwise it's they can start drowning you.Do you have a system for it or do you have a yeah.Any suggestions?I'm really starting to talk a lot about the client bashing piece because I think that's the fastest, like in the moment way for us to recognize the minute that I want to start client bashing, I probably need to examine what the what my real emotion is.
And, and so really started to talk to veterinarians about that and staff, right, because staff are are great client bashers too.It's not, this is not just a veterinarian opportunity.And so really turning to use that as a, the minute I want a client bash.Can I think twice about why I want to do that and instead talk about my emotion?
And what's pretty interesting is that's that I've talked to about this that have experimented with it and they do see the difference in the room about how the room changes when they're able to do that.OK, And then out of the the moment when it happens post work week, having somebody to connect with and and talk about as you said, you, your your mates don't want to hear about this.
Have you guys got anything in place for that or or because I'm just trying to think what how could you fix this?Having a group of trusted people who you can discuss this with, which we don't all have to be honest.No, a lot of us do and we don't even know it, though many veterinarians are part of online groups on some platform or another that are only veterinarians.
And so many of us do have veterinary only spaces where some of this could be discussed.So that's an option, right?The other is there's an amazing group called the Veterinary Hope Foundation.And they do offer six week programs where groups of eight veterinarians meet once a week to share on any topic.
But this could certainly be the type of thing that would be shared.So they, and this is all free, the Veterinary Hope Foundation.And so they do really impressive work.So that's a group that's focusing on groups of veterinarians meeting together in small cohorts to work through some of the things that they're experiencing.
So that's something that's organized, but I also think it's something that could be easily organized within an individual practice.No matter how many people, even if the single vet practice once a month, they could sit down and have a conversation about these topics.And even though it's tough, like you said, we don't necessarily want to relive that most difficult case over the last few weeks.
It's an important thing to sit down and talk through what our actual feelings are.So small practices can implement this, big practices can implement this.It doesn't cost you any money if you want to.Everybody bring your lunch and on the 4th Thursday of the month we're going to eat lunch together and talk about this.
I'm trying to think for myself and it's interesting why I feel as a part of me goes, I think I'd rather do it with people who I don't work with.Interesting.Maybe it's better ego, maybe it's that vulnerability piece.Maybe I not that comfortable being that vulnerable with people.
I I feel like it'll be almost downer sessions, like a bitching session.Let's talk about a lot of problems with my colleagues, whereas I want a positive workplace.But but that's I wonder if I'm the only one who feels that way.So when you talk about the Hope Foundation, I like the idea of saying, OK, there's these other people, yeah, I don't have to steal them again for, for my, and I could be really open and I can really share it.
I can cry if I want to.Understand, I do think if it's in an individual hospital, you would need someone that had a pretty high level of emotional intelligence to be leading that group because you would want to steer it away.
Like we don't want to start with a I'm feeling vulnerable and move into client bashing.Yeah.So someone would need to kind of lead and and steer that group.Client bashing and then I worry that it will turn into a potentially leadership bashing or or problem solving session to say well how can we prevent it?
It'll turn into a meeting instead of just a conversation and.It needs to be a conversation about, you know, like I the example I gave like that made me really sad.All I can think about is that dog that can't breathe and and all I need you to say back is, yeah, I feel that way too.
And I think I've, I can think of this very specific example where that did work.I did it accidentally and a, a massive difference immediately.It was AI had a, it was an early morning dog in labour with a, the young client who was obviously just clueless and had left the dog in labour for two days.
And she came in on death's door.And I remember this overwhelming fury at this guy and coming out to back and the nurse could, I could see she was the same.We were both there was a massive tension.And for, for some reason, I, I just said I just was honest with her and said, I'm so sad.
I'm so, so, so upset.Then it helped.That definitely, definitely made a big difference.I remember driving home going, wow, normally I would be in such a bad state of mind after that concert that the last concert for the day, of course, of the shift and I didn't.I felt a sort of a lightness and spirit for having that moment with a nurse where we always just said, yeah, that sucked.
Yeah.So yeah, it helps.It does, It really does.And there's a great phrase that I have come across in some of the reading which is a problem shared is a problem halved.And I think that's a very simple way to talk about how that sharing makes the problem feel lighter.
And the science behind it, because it's one of those things that your Gran would say, but he said you go, no, there's actually data that says this is true.Like because if it feels too simple, but it's just a thing the the scientist in me goes, no, no, there's got to be more.I've got to get some.I've got to do some exercise and maybe take a medication or something.
Just say yeah, talk to some friends about it.You'll feel better.Seems seems too simplistic, but it's great that it's so simple.Yeah.And there's so many ways to do this that are effective and easy and we often to over complicate our solutions I think.Yeah.
Well, Shannon, is there anything we we missing out on or do you think?I feel like that's opened my eyes and hopefully people listening as well, because you're right, the default is to go.I'm burnt out.That's the that's the, and I'm sure that's how you feel, but maybe if there's one message from this is to say, well, be specific about how you're feeling.
I'm I have strong negative emotions about work.Try and put your finger on it.And then when this is an easy enough thing to say, well, baby, it's maybe it's this, it's yes.If I think back to the month preceding how I'm feeling now, I have had a lot of that and before I and it's such an easy strategy, right?
It's not like I have to do anything dramatic to say, well, let me see if I, if I reach out to a group and if it does help alleviate what I'm feeling, as you say, because there's often multiple of these things happening at the same time.Well, address this one.Cross that off the list.Treat and see.One of my medicine lectures used to say, for your patients, treat what you see and then see what you're left with.
Yes, I think that works.I think that absolutely worked.And you know, if, if we're feeling burned out, it's never wrong to do the steps for that too, right?Like change your schedule a little bit, take it some time off, do some of the mindfulness things that we know are really effective.
There's all kinds of strategies that are going to help.But if we just do those and we don't examine this moral injury piece, then we're not really going to feel that much better.OK, are we done with moral injury?I think so and.You're not going to get away without the standard questions.
So podcast first.Do you do listen to podcasts?Yes.Definitely all the stuff that you do because you're, you're like a super endurance athlete as well, aren't you?I I do a lot of endurance stuff too, yeah.What do you do?So I really love adventure racing.
Do you know what that is?Yeah, I I think I have a pretty solid idea.Is that where you torture yourself for days on end running and cycling and cracking?That's right, yes.Map and compass navigation and mountain biking, hiking and paddling.
And the winner of an adventure race is the person that gets to the most checkpoints in the least amount of time.And I like to do these on all female teams, which is pretty cool.Historically, this has not been an all female kind of a sport.And so it's really fun to get out there with a group of women, do some cool stuff in the woods.
Wow.OK, so the reason that came up, I was going to ask, when you are training for these things, do you listen to podcasts?I do, yes, for sure.So.What's high on your playlist at the moment?So I'd love one called the Veterinary Life Coach Podcast with Doctor Julie Capel.
She's also written a book in the last year or so.And I love the way that she approaches things because her approach is all about you can love being a veterinarian and she helps people move towards that, which I love.Any non veg stuff that you listen to?
I like military history a lot, so I tend to listen to some things like that for sure.And there are adventure racing podcasts.And so if I'm preparing for a big race, then I will listen to a lot of race directors will do podcasts in front of a race.
And so that's kind of required listening because they might give you little clues that will help you to prepare better.All right.Books.Anything that you've read recently that just changed the way that you think about the world?So Kristin Hanna is an author that writes historical fiction, and I read 1 of hers recently that it's called The Four Winds, and it's about the Dust Bowl and it's fiction, but it's about the true Dust Bowl.
That happened in the 1930s in Oklahoma and Texas.And a lot of folks migrated from those areas to California and they were treated absolutely horribly.And it was fascinating to think about our migration migrant issues that we have in the world today in 2024, and read about very similar issues that happened in the United States in the 1930s and how history repeats itself.
Is Steinbeck's Grapes of Wrath said in that same?That's the same.Same setting.Same period, right?Same setting.Which is also not a a fun book.No, and this one ends ends well, Christian.It's historical fiction, right?So she needs it to end well.But but it was really enlightening.
OK, pass a long question.So the one that you are landing with.So we're this is a previous guest has asked me a question not knowing who it's going to be for.And he asked if you had to knowing what you know about the vet profession, if you could start completely fresh and redesign the whole profession.
So burn it down, burn it to the ground and rebuild it in the way that it should be.What are some changes that you would make?It's a big question.I know this is what I was really glad I had a day to think about, but I did come up with a an answer that I'm happy with.
I wish we did way more education about how to run a small business in veterinary school.Like a lot of it not like the one semester class that I think now they get now.I got none in vet school in the 90s, right?I think now they're getting some, but I wish we did a lot of it because I wonder how our landscape would look differently if veterinarians had been very well trained in business for decades.
What would our corporate landscape look like?How would it be different?And so if I had one thing, if I could go back and do it all differently and I was the only one in charge, I would do a lot more business education.Yeah, that's a great point because you're right.We we did one Friday afternoon in a in a six year program.
I will never forget a lecture in 3rd year.I went to Texas A&M, where the speaker spent an hour talking to us about how we needed to wear ties.Obviously, the ratios of that students were different at the time, but I mean, there were a lot of women in my class and I was like, for real.
Like we're still sitting here listening to a lecture for men and about men's attire.Wow.So it's changed as you say.You wonder because the limitation there is you have X amount of time to get all of this clinical vetting stuff into your skull so that the pushback would be how do you fit that into the program?
You wonder almost if you could have a specific veterinary business degree for not necessarily the the doctors for to say, well, have people who study that to say I want to be a vet practice manager, something like that.But yeah.OK, great answer.I like that a lot.Your question for my next guest please.
So I have a signature question, so I didn't have to think about this at all.And I ask people all the time, everywhere that I go.Tell me something you learned today.All right, last question.Our wrap up question is always you have the opportunity to speak to all of the veteran and new grads of the world.
Maybe you're on a podcast and you have a couple of minutes to give them just one little bit of advice for their veteran careers.What's your bit of advice?Do not be afraid of your clients.The clients have the answers to all of the questions that you need to solve your case.
And if you are afraid of them and you avoid talking to them, you will miss out on essential information and you will make the wrong diagnosis and it will all be harder.And I know you're terrified to go into that room and talk to them when you are not sure what's wrong with their pet.
It's OK to not know and it's better to ask them the questions yourself and be in relationship with the owner of the pet.I love that one because you're right, there's often a a confrontational vibe of US against them and they're the stumbling block to the answer.
But no, they're the key to the answer.You're on the same team, you want to do the same thing, or in the end you maybe have different opinions on how to get there, but it's the same goal.I see so many early career veterinarians that use the technician as the go between and they keep sending the tech back in to ask the owner more questions.
And it's all about fear that they're afraid that if they go in and, and the client asked them a question that they don't know the answer to, they they don't know how they're going to handle that.And it's OK to just say, I'm not sure I'm going to look that up.I'm not sure I'm going to consult a colleague.Let's wait for that test result and then we'll talk more.
They're all kind, all kinds of great responses when you don't know the answer and it's OK.So thank you so much for spending the time with us.Thank you for for suggesting this where we met over a coffee at at Ivex.And I'm so glad you read that book that said to down this whole rabbit hole because it really was eye opening and I think it will help anybody who lives.
Have you found talking about the topic in your hospitals that you're getting good feedback that yes, actually recognizing it because it's self-awareness, right?It's it's being aware that this is something's happening.I recognize that we oh, I think I know what it could be and let me let me act on it.
Is it helping?It's very eye opening for people.Most people haven't heard the term and so it's very eye opening and everyone that I talked to about it's like, yeah, that's that's happening.And I, I felt that having this conversation with you, I've heard the term, but I wasn't clear.
And I, I felt that little bit of a light bulb going.Oh, yeah, that explains a couple of things.Well, thank you so much for sharing with us.Appreciate the time.Thanks for having me, I've enjoyed it.Right, it is time for our end of episode Humblebrag, where I share my favorite Red Vault review of the week, overlaid with some inappropriately dramatic music.
I do this for a couple of reasons.Number one, to publicly thank the people who do take the time to review and like what we do.It really means a lot to me personally and it keeps me motivated to make something useful.So thank you #2 to remind you to please leave us a review or a star rating on your podcast player of choice.
Because when you do that, you tell the Apple and Spotify algorithms that this is a podcast worth listening to.So it starts showing it to more people like you #3 the dramatic music is mainly because my editing software has this vast library of music that I never get to use and this gives me an excuse to have a bit of fun with it.
So review time.Short and sweet, but really lovely.Michelle writes compliments of the season.Compliments of the season to you too Michelle.I found the free podcasts which you did with Gerardo Polly and subsequently subscribed.Smart move Michelle, thank you.I thoroughly enjoy the content and particularly like your humour and humility, saying when you don't know something and clarifying points from the perspective of AGP event.
Keep up the good work.Thanks Michelle, I promise that I will keep up the good work and rest assured, I've been doing this for many years now and it seems that there is minimal risk that I will ever get to the point where I do know so much that I no longer need to ask my questions.OK.Thanks for listening.
We'll see you next time.

Dr. Shannon Bass