Your Notes in Court: Medical Reports Explained

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Every doctor writes notes, but at some point in your career, someone is going to ask you for a report. It might be an insurer, a lawyer, an employer, or a court, and suddenly the rules change. You're not just documenting care, you're providing evidence. What's the difference between a treating doctor's report, an independent medical examination, and a permanent impairment assessment? Who's actually qualified to write each one? And what happens when your report ends up in front of a tribunal or you're called to the witness box? Today on Aussie Med Ed, we're demystifying the medical report. What is it? Who writes it? And how is it used in Australian courts and tribunals? Good day and welcome to Aussie Med Ed. The Aussie style Medical podcast a pragmatic and relaxed medical podcast designed for medical students and general practitioners where we explore relevant and practical medical topics with expert specialists. Hosted by myself, Gavin Nimon, an orthopaedic surgeon, this podcast provides insightful discussions to enhance your clinical knowledge without unnecessary jargon. I'd like to start the podcast by acknowledging the Kaurna people as the traditional custodians of the land on which this podcast is produced. I'd like to pay my respects to the elders, past, present, and emerging, and recognising their ongoing connection to land, waters, and culture. I'd like to remind you that all the information presented today is just one opinion, and there are numerous ways of treating all medical conditions. It's just general advice and may vary depending upon the region in which you're practicing or being treated. The information may not be appropriate for your situation or health condition. And you should always seek the advice from your health professionals in the area in which you live. Today on Aussie Med Ed, I'm delighted to welcome back Dr. Mary Obele. Mary is a specialist occupational and environmental physician, a fellow of the Australasian Faculty of Occupational and Environmental Medicine of the Royal Australasian College of Physicians, with a background in general practice as well, holding fellowships of the Royal New Zealand College of General Practitioners and a diploma in occupational medicine with distinction. Medical reports sit right at the heart of her day-to-day work. She prepares treating doctor reports, independent medical examinations, and permanent impairment assessments across the workers' compensation and personal injury systems, working with injured workers, employers, insurers, and lawyers. And she understands what happens to these reports once they leave the doctor's desk and enter the courts and tribunals. Mary, welcome back to Aussie Med Ed. It's great to have you on board again. Thanks, Gavin Perhaps you can start off by telling me what actually is a medical report, and how does it differ from clinical notes we write in everyday practice? Oh, that's a really great place to start, Gavin. people often think they're the same thing, but they're definitely not. clinical notes, we write those to support patient care, don't we? So it's a contemporary record about what's happening during the consultation, what the patient told you, what you found on examination, your diagnosis, your management plan, and I guess it's written mostly for other treating clinicians to see what's going on. But a medical report is something quite different. It's more of a considered and structural opinion, and it's written for a very specific purpose and a specific audience. So that audience could be an insurer or a lawyer or an employer or even a tribunal or a court. And not only do we just record what's happened, you're actually answering a very particular question using your medical expertise. So, I often tell the junior doctors that the clinical notes are like the building blocks, whereas the report is the finished building. So if your notes are really thorough and accurate, then writing the report will be a lot easier. But if your notes are, shall we say, sparse, well then it's like baking a cake with half the ingredients. And we've all seen those notes that say, "Back pain ongoing." And maybe that's enough for that consultation, but it doesn't tell a court very much five years later. And I guess another important difference is that a medical report usually requires analysis. You're weighing up that history, the exam, the investigations, all the available information before reaching your independent medical opinion. So it's more than just repeating what the patient said Right. Well, who actually ends up requesting these medical reports? Is it insurers, lawyers? who actually asks for them? well, Gavin, the short answer is all of them. medical reports are requested whenever someone needs an independent medical opinion to make a decision. So it could be an insurer assessing a workers' compensation claim or a motor accident claim or, income protection or total and permanent disability. Or it could be a solicitor acting for either side of the litigation, or it might be an employer just wanting some advice about fitness for work or, workplace adjustments, And sometimes it's a tribunal or a court that's seeking expert evidence. And I guess the important thing to remember is that although somebody actually commissions and pays for your report, they don't get to dictate the opinion. And I think that's one of the biggest misconceptions, isn't it, Gavin, that people have. And I often explain it this way. So if you pay, say, one of those house inspectors to inspect your house, you don't get to choose whether they find cracks in the foundation. So you're paying for their expertise, but not their agreement, and it's exactly the same with medicolegal medicine. My opinion belongs to me, not to the person who requested the report. And sometimes that actually surprises the patients as well because they say, "Oh, you're just the insurance doctor." And I gently explain, "No, I'm the independent medical specialist who's been asked to answer some specific medical questions." And that independence, I think is, and I'm sure you'll agree, is absolutely fundamental Very much so. So which doctors end up writing them? Is there something every doctor will encounter or is it a specialised area or practice? Oh, no. I think every doctor will write some form of medical report sometime during their career, won't they? GPs are asked for reports all the time. specialists, I'm sure you do, provide reports for insurers, lawyers. Hospital doctors also do reports for compensation or coroners. So it's something that every doctor should understand. but the more specialised medicolegal report, like the independent medical examination or a permanent impairment assessment or an expert witness report, that develops with experience. So the doctors doing this kind of work generally have quite a lot of clinical expertise in their specialty before they move into medicolegal practice. And sometimes people imagine that medicolegal work is separate from clinical medicine, but really it's an extension of it. You're still applying all the same principles of diagnosis and pathology and evidence-based medicine, and the difference is that you're applying those principles, to answer the questions that they've posed rather than making a treatment decision like we do in our clinical practice Brilliant. So you've touched upon a few different types of medical reports. Let's define each one. at the beginning you mentioned the treating doctor's report. What does that typically contain? Well, the treating doctor's report is about that ongoing therapeutic relationship. It communicates the relevant medical information about the diagnosis or the treatment or the recovery or maybe the prognosis. And usually it contains the patient's history, the physical examination findings, investigations, diagnosis, treatment, their current symptoms, medications, maybe something about their functional limitations and also their expected recovery. And sometimes that report will answer some very practical questions like, can this person return to work? Are they fit for modified duties? do they require some ongoing treatment? And in terms of treating doctors, I always emphasize avoiding, that drift into advocacy 'cause we're all naturally very empathic towards our patients, aren't we? It's part of being a good doctor, but our reports still need to be very objective. So supporting our patient doesn't mean overstating the findings, and I think a balanced report like that shows both sides is often far more persuasive than one that's one-sided Excellent. So what actually is an independent medical examination then? You mentioned that earlier on as well so the independent assessment is done for a really specific medicolegal purpose. So the assessment begins with a review of all the information provided, and that could be hundreds and even thousands of pages, as you know, Gavin. It can be GP notes or specialist reports, imaging, hospital records, a lot of employment information. And then you go into the consultation itself, and that involves, again, taking a detailed history, doing an examination where it's appropriate, and then considering all the available evidence before you, come to your independent opinion. So it's important to understand that it isn't a treatment consultation, Well, I always explain that to patients right at the beginning because it really helps to set expectations. So I say, "Today, I'm not acting as your treating doctor. my role here is to assess your condition independently and answer the questions that I've been asked." And that clarification often avoids a lot of confusion later. So as you know, people arrive, and they're understandably really anxious 'cause they've heard horror stories about these IMEs. And most leave saying, "Hey, that wasn't nearly as bad as I expected." And I think that comes back to treating patients with respect and explaining the process and really listening to them carefully. And even if you're not providing treatment, you still have to be professional, and compassion still matters Well, then there's obviously a different type of independent medical report called a permanent impairment assessment. And what's the function of that and what is, it actually measuring? I think you'd agree, Gavin, that that's the one that causes the most confusion. So a permanent impairment assessment is measuring, permanent loss of body function. So it's not measuring pain, it's not measuring disability, and we're certainly not deciding whether someone deserves compensation, and we're not judging whether they're a good or a bad person. It's actually an objective assessment, and it's done according to some very prescribed guidelines. So I use the car analogy here. If you've had a significant car accident, the mechanic assesses the permanent damage to the vehicle, but they're not deciding whether you were a careful driver or whether you need a new car. They're simply measuring the damage, and that's what we're doing, but medically. And, patients often find that explanation quite reassuring because they realize that we're measuring something very specific rather than judging them Really, it's a great analogy. what are the key differences between the threes in purpose and who commissions them and the doctor's role? Well, I think you've already said it, Gavin. The big difference is the purpose. the treating doctor focuses on helping the patient recover. The IME doctor wants to provide that independent opinion, and the permanent impairment assessor is objectively measuring the permanent impairment according to the, applicable guidelines. And so they're very different roles. And also the person requesting the report also differs. So treating reports, they're usually asked for by, insurers or employers or lawyers because they need information from the treating clinician. And then the IMEs usually commissioned by insurance or legal, and then permanent impairment assessments are requested under very specific statutory compensation schemes or during litigations. And so as a doctor, you have to remain really conscious of what role you're actually doing at the time, because wearing two hats can, as you know, create confusion and conflict in an independent medical examination, do you actually form a doctor-patient relationship? and does that differ from, say, a treating doctor? Oh, that's a good question, 'cause it's the one that even many doctors find confusing So the interaction is professional and it's respectful, but it is fundamentally different from that therapeutic treating doctor-patient relationship because the purpose of an IME, that's not diagnosis or treatment, it's an independent assessment. And that means I'm not taking over the person's care or prescribing ongoing treatment or becoming their specialist. of course, if I identify something that requires urgent medical attention, I have an ethical obligation to act. But ordinarily, my role ends with providing my opinion to the commissioning party. And I always explain this clearly before we begin, and I think patients really appreciate knowing exactly why they're there and what my role is, because that transparency builds trust, even in situations where people are understandably a bit nervous about the whole thing. Well, perhaps you can give us a few examples or typical scenarios when each type of report's used. So a workers' compensation claim or other ones Oh, the reports are found in all sorts of different settings. So say a worker injures their shoulder lifting some heavy equipment, and so their GP is gonna provide the treating reports which document their diagnosis, the treatment, and their capacity for work. And then their insurance, they could request an independent medical examination to get an independent opinion about the diagnosis, the cause, the treatment for the shoulder, and the work capacity. And then if the worker reaches maximum medical improvement and the legislation requires, then they may need a permanent impairment assessment to determine whether they've met the relevant impairment threshold. or say it's a motor vehicle accident, so reports are needed to determine what injury they've had, ongoing treatment, and long-term impairment. So then there's income protection, total and permanent disability claims. They involve specialist reports, often about functional capacity and prognosis. And even though all those settings, they vary, the underlying principle is always the same. Good medicolegal reports are objective and they're evidence-based and they're clearly reasoned, 'cause at the end of the day, it's not our role to decide who should win the case. Our role is to assist the decision-makers by providing them with a reliable medical opinion. And if we stick to that, then we're doing our job properly Excellent. Well, are guidelines resources used to help prepare these reports? I've heard of the AMA guide to the evaluation of permanent impairment. Perhaps you can tell me a bit about which guides are actually used and what these are. Oh, this is where I found out that medicolegal medicine's far more structured than I expected. So we're not simply giving our opinion based on years of experience, even though clinical judgment is obviously important. But those permanent impairment assessments are done using prescribed guidelines, and those guidelines depend on the compensation scheme and the jurisdiction. So, as you said, the American Medical Association's guides to the evaluation of permanent impairment, the AMA. But it's important to understand that in Australia we don't use them in the same way that the United States does. So many Australian jurisdictions, have adopted an edition of the AMA guides, like four, five or six, and they've modified them through their own legislation and the state-specific guidelines. And that's really important because you can't assume that the same methodology applies everywhere. So as medicolegal practitioners, we also rely on the clinical records, the diagnostic imaging, the pathology, all the specialist reports, as well as peer-reviewed literature where that's appropriate, and the relevant legislation and the scheme rules. So I often tell my trainees that doing these permanent impairment assessments is a bit like following a recipe. So you can be a really excellent chef, Gavin, but if you decide to ignore the recipe and throw in your own ingredients, well, don't be surprised if the cake doesn't rise, and it's the same here. And so it's consistency, isn't it? Consistency is the reason why all the guides exist obviously the different guides are used to work out a whole-person impairment. What actually is a whole-person impairment? but what actually does it mean? Oh, whole person impairment, WPI, you hear that word or that term a lot, don't you? But it isn't always well understood. it's a standardized way of expressing the permanent impairment as a percentage, of the overall loss of your body function. So important to remember what it isn't. It isn't a percentage of pain or a percentage of disability or a percentage of someone's ability to work. So someone can have quite a low whole person impairment percentage, but they still might be completely unable to perform their job that they previously did. But on the other hand, another person can have quite a high percentage impairment, but they can continue working very successfully. So they're all different concepts and the calculation itself follows the applicable impairment guidelines. so it isn't something that the assessor invents. Each body system has prescribed methods of assessment, like the lower limb or the spine or the, eyes or whatever it is, and where there's multiple impairments, then they're combined using a formula. They're not just added together. And patients are sometimes surprised by that. They'll say, "Oh, I've injured my shoulder and I've injured my knee. That's twenty plus twenty equals forty." Unfortunately, medicine isn't quite that simple, so the calculations are designed to, avoid overestimating the combined effect of the multiple impairments Thanks for that, Mary. What does a typical assessment appointment involve for the person being examined and assessed? Oh, most patients have never attended an independent medical examination before, so naturally they're a little anxious. So the first thing I do is explain exactly why they're there and what my role is, and I think that immediately puts people at ease. And then the consultation usually begins with a detailed history, and that covers the mechanism of injury, the treatment, the current symptoms, their functional limitations, their employment history, and their relevant past medical history. And then there's, a focused physical examination depending on the condition being assessed. And sometimes you need, extra measurements under the applicable impairment guidelines. And throughout the assessment, I'm comparing the history, the examination findings, and the medical records to see if everything's consistent. And one patient once said to me,"Oh, I thought that was gonna be like an interrogation." And instead they said that they felt it was like a thorough specialist consultation. And to me, that was lovely to hear because although we're doing an independent assessment, people still deserve, politeness and respect and clear communication. And being independent doesn't mean being impersonal Well, what training is required to perform these permanent impairment assessments and other types of assessments as well? Can any doctor do them? the short answer, no. Not every doctor can simply wake up one day and decide to start performing, permanent impairment assessments. So the exact requirements depend on the jurisdiction, and there's formal training and accreditation that are required before doctors can do these assessments within the different statutory compensation schemes. And there's lots of courses around, and they teach the methodology behind the impairment guides, how to do the assessments consistently, and how to apply the legislation correctly. So clinical experience is obviously very essential, but it's only one part of the picture. So I often compare it to learning to fly. So just 'cause I'm an experienced traveler or you, Gavin, doesn't qualify us to pilot the aircraft. And just the same, being an excellent clinician doesn't automatically qualify you to do permanent impairment assessments. You also need to understand and learn the assessment methodology and the legal framework in where you're working Well, I mean, how does accreditation work then? Who runs the courses and what are they involved and how long do they take then? varies according to the jurisdiction. Generally speaking, accredited training providers, they run these, structured courses, and they cover all the relevant impairment guides and the practical assessment techniques, the report writing and the assessment methodology. So there's usually a bit of pre-course reading, and then there's in-person or online training, and then there's some practical exercises and a formal assessment before accreditation is granted. And some jurisdictions have panels of accredited assessors. Others have different requirements depending on the scheme. So the important point is that the accreditation isn't just attending the weekend course. It's about demonstrating that you can apply the guidelines accurately and consistently. And it's that consistency that's essential because decisions involving compensation often depend directly on these assessments Right. And are there any ongoing requirements to maintain accreditation? And do they differ between jurisdictions as well? Oh, yeah. absolutely. So, they do change. So medicine changes, legislation changes, and impairment guidelines are updated. so most jurisdictions require ongoing professional development and refresher training, periodic reaccreditation and some also, require you to complete a minimum number of assessments or, to participate in quality assurance activities as well. And the requirements vary between the schemes, and so that's another reason why medicolegal practice requires that ongoing learning. It's certainly not something that you can learn once and then put on autopilot. You've gotta keep your eye on the ball Right. is this all the same for IMEs and treating doctors, or is permanent impairment assessments even harder than the other two? And what other formal training is required for the IMEs and treating doctor reports? Well, interestingly, there isn't usually mandatory accreditation to write a treating doctor's report. every clinician writes report as part of their routine practice. But, writing a good medicolegal report, that's a skill in its own right. So way back then, medical school taught us how to diagnose disease, but it didn't necessarily teach us how to write an expert opinion that's gonna stand up to legal scrutiny. So doctors performing independent medical examinations don't usually require formal or statutory accreditation in the same way as those permanent impairment assessors, although a lot of us do do extensive education and medicolegal practice and report writing and expert witness work. And I'd strongly encourage any doctor interested in this area to seek, out some good mentoring before jumping in, and reading good reports written by your experienced colleagues is one of the best ways to learn Well, obviously that's one tip. Are there any other tips you can give for someone interested in medical legal work? And what's the usual pathway to get into this area? I think it, evolves quite naturally, Gavin. So you become known for being a really careful clinician who writes those clear and balanced reports, and then your colleagues notice, lawyers notice, insurers notice, and before long you're being asked to provide your opinion more regularly, and that's generally how it starts. So my advice would be to build a very solid clinical career first, because your credibility as an expert rests on your clinical expertise. And learn to write well. Keep your reports objective. stay within your area of expertise and find some experienced mentors. get the right education, and don't be afraid to say, "That's outside my expertise." That's one of the hallmarks of a really good expert to say, "Well, that's not in my field. That's beyond my field of practice." And I guess also remember that your reputation is your greatest asset. So a doctor who's known for being fair and balanced and evidence-based will always be more valuable than someone who's, perceived as advocating for one side or the other.' Cause at the end of the day, our opinion should be able to stand up to scrutiny regardless of who commissioned the report, and if you can honestly say that, then you're on the right track Well, finishing up, what are the standard components of a medicolegal report? I mean, is there anything particular that varies between the types of reports, and how do you normally proceed? I think a good report has a logical structure, and every section has a purpose. So most reports start with the administration. So who requested the report? Who was examined? When did the assessment take place? What documents were available? Then we move into the history, not just the history of the injury, but the past medical history and the medications, the work history, the treatment received, current symptoms, functional capacity, and then the physical examination findings, and these need to be objective. If I've measured a range of motion or identified some neurological signs, I record exactly what I find, not what I hope to find. And then after that, I summarize all the relevant, investigations like imaging, pathology, and only then do I provide my opinion. And I think that's an important lesson for junior doctors. Don't jump to the conclusion first and then work backwards. Show your reasoning. Let your reader follow your thought process. And then finally, I answer the specific questions that I've been asked. And that might sound obvious, but, I'm sure you won't be surprised Gavin, at how many reports never actually answer the questions in the referral letter. So I always tell my trainees, if they've asked six questions, then make sure that you've answered all six. It's kind of a bit like sitting an exam. You don't get marks for answering a completely different question, even if your answer's brilliant Well, are there any formalities that apply? I mean, are there any statements you have to make during the report or, other comments you gotta put in? depending on the jurisdiction and and the court. So, usually you set out your qualifications, your experience, your expertise so that the reader understands why you're qualified to provide an opinion. And then you'll, have a declaration confirming that you've read and complied with the relevant, expert witness code of conduct, and that your opinions are independent based on your own expertise and not generated by, AI. And you're also, expected to identify your assumptions that you've made, limitations in the information, and whether there are any questions that fall outside your expertise. And good experts aren't afraid to say, "I don't know." In fact, it's one of the strongest things that an expert can say, 'cause no one actually expects us to know everything. What they do expect is honesty about the limits of our knowledge well, where do these reports end then? What's the range of courts and tribunals in Australia that deal with medical legal matters and, how else are they used Oh, I've been surprised at just how many places medicolegal reports are used. many reports never see the inside of a courtroom. They're used by insurers to make decisions, about treatment or liability or compensation. other reports can be relied on by, the worker compensation authorities or motor accident schemes or administrative tribunals. some go to formal litigation and state courts, occasionally federal jurisdictions, depending on the nature of the matter. And, the reports can also be considered during settlement negotiations, long before anyone reaches a courtroom. And in fact, a well-written balanced report can sometimes help resolve a dispute without the need for a trial, and that's a good outcome for everyone, Gavin. our reports aren't there to inflame conflict. They're there to clarify medical issues And there's different forums that might be used as well. I believe there's things like state workers compensation tribunals, such as in South Australia, the South Australian Employment Tribunal or district and supreme courts, federal courts, administrative tribunals. Must get very confusing trying to work your head around all of that. Well, each, Australian jurisdiction does have its own legislative framework. So the exact forum depends on the type of case. So as an example, workers' compensation disputes, could be heard by a specialist tribunal or a commission established under the state legislation. motor accident claims go through statutory authorities or the court. civil litigation, personal injury, district court, Supreme Court, depending on the complexity and the value of the claim. some matters go through administrative review bodies. and wherever it's going, Gavin, as you know, the principles don't really change. Whether the report ends up before a tribunal member or a Supreme Court judge, your job is exactly the same. Provide an independent, evidence-based medical opinion. The audience can change, but your professional obligations don't I believe when you provide an independent medical report and you present it to a court or a tribunal, then you're called an expert witness. Is that correct? And what's the role of this expert witness to the court? What's their duty? well, I guess an expert witness, owes their primary duty to the court or the tribunal, not to the person paying the invoice. so people often assume that just because an insurer or a solicitor engaged you that you're somehow on their team, but you're not. and that's the principle that every expert needs to understand from day one. so I explain it this way. Gavin, you're the umpire in the cricket match, and one of the teams paid for hiring out the grounds, but you're not gonna give them every decision, are you? Your role is to apply the rules fairly and objectively. So it's the same principle. If my opinion happens to support the party that instructed me or paid me, that's because the medical evidence supports that conclusion, and if it doesn't, then it doesn't. So, changing your opinion to please the person paying you isn't just unethical, it would completely undermine the purpose of expert evidence. your credibility takes years to build and only minutes to lose Mary, what happens procedurally when a doctor is called to give evidence? well, fortunately, most times we aren't required to attend court. But if you are called, it's usually because, the court wants to clarify some aspect of your opinion. So usually, you'll be asked questions by the party who called you, and that's called examination in chief. And then after that comes the cross-examination, and that's when the opposing barrister tests your opinion. So people often imagine that that's gonna be really dramatic 'cause we've watched lots of, TV shows, but the reality is it's very measured. So yeah, the barristers ask challenging questions. That's their job, but they're not testing your confidence, they're testing the strength of your reasoning. So one of my mentors gave me some advice many years ago that I've never forgotten. So they said, "If you know the medicine and you've written an honest report, just tell the truth." And actually, that's really good advice. And if you don't know the answer, just say so, and if you've made an error, then just acknowledge it. And trying to bluff your way through cross-examination is like trying to wrestle a crocodile. It usually doesn't end well Right. What are your key take-home messages for junior doctors or GPs asked to write their first report? Firstly, remember that your report is gonna be read by people with no medical background. So lose the unnecessary jargon. explain your reasoning really clearly and be objective. So your job isn't to advocate for one side, it's to provide an honest medical opinion based on the available evidence. And stay within your expertise. If something falls outside your knowledge, then say so. And take your time, because a rushed report, in my experience, often creates more work later. And never forget that your clinical notes matter. So today's consultation notes could become tomorrow's crucial evidence. And of course, we know that paperwork isn't everyone's favorite part of medicine, and no one went through medical school dreaming about writing reports. But good documentation, Gavin, as you know, protects our patients and supports good clinical care and if it's needed years later, it helps us to provide reliable expert opinions. It's that old saying, "Cento misuro, uno taglio," measure twice, cut once. a little extra care today can save a great deal of trouble tomorrow Well, where can listeners go for more information about this if they want to learn about training to become an expert, to provide independent reports or permanent impairment assessments, or just wanna find out things in more detail? Have you got any resources you'd recommend? Oh, start in your own specialist college and also the relevant compensation authority in your state or your territory. read the AMA guides and also the state-specific impairment guidelines if you're interested in the permanent impairment assessments. there's really excellent courses on medicolegal report writing, expert witness skills, and independent medical examinations, and they're through professional organizations' accredited providers. but perhaps in my mind, the most valuable resource is finding a really good mentor. So read those high-quality reports, discuss the difficult cases, learn from your experienced colleagues. That's invaluable 'cause medicine's always been like an apprenticeship, and medicolegal practice is no different Brilliant. Well, thank you very much again, Mary. It's been great to hear all about this. I really think you've summarized it beautifully, and, appreciate your time. I know you've had a busy day. Is there anything else you'd like to add as we say goodbye to the audience? I think I'd just like to say, being an expert isn't about being the smartest person in the room. It's about being the most trustworthy. And if you're known for being, fair and balanced and respectful and evidence-based, then people will seek out your opinion because they trust your judgment. So your reputation is worth, protecting. before I send off every report, I always ask myself this one question. So the question is, if a judge and another specialist or the patient, and they all read my report together tomorrow, would I still be comfortable with every word that I've written? And if the answer is yes, then I'm probably on the right track Well, thanks again It's great to hear about this, really important and also very common topic. so we really appreciate it. Thank you very much, Mary, Thank you. It was great Thanks again for listening to the podcast and please subscribe to the podcast for the next episode. Until then, please stay safe.