It's a pleasure now to introduce Dr. Gretchen Schworzy. Gretchen's an associate professor of surgery at the University of Wisconsin. She is the holder of the Morgridge Professorship in Vascular Surgery. Gretchen's nationally recognized expert in surgical decision making with a focus on improving communication between older patients and their surgeons. And she has a particular interest in aiding patients and doctors in making medical decisions which support patient preferences, values, and goals. About 10 days ago, Gretchen gave the very prestigious John Jay Conley lecture in ethics, I'm sorry, in philosophy and medicine at the American College of Surgeons Clinical Congress. And it was outstanding. And I think anyone who is there knows what a wonderful speaker she is. So it's a real pleasure to welcome Gretchen back. Thanks, Peter. OK, hopefully the acoustics are all right here. Any two seconds? All right, so wow, this is a tough group. That was a really extraordinary presentation by Alex. I haven't seen anybody tease out the realities of the collaboration that happens in the operating room. So it was brilliant. I'd like to both acknowledge my funders and express my frustration with my husband who has invested tons of our money in this meslite business with absolutely no return. But somehow it needs to be on my disclosure slide. And in the Shorzi lab, we have three rules.  The second rule is follow the data.  So today I'm going to talk about some work that actually began here many, many years ago after a question that Rachelle Benackie asked at the end of one of my talks. And it really goes along the lines of this issue of follow the data. And Rachelle stood up at the end of a talk. And I honestly don't even remember what I was talking about at this point, but she said Gretchen, why is it so hard for surgeons to withdraw life sustaining treatments on their post-operative patients? Is it just because of their outcomes and their mortality statistics, or is there something else going on? I was like, wow, that's a really interesting question because it seems like it has an obvious answer, but it doesn't really ring true. And while I'm not going to talk about surgical buy-in and all the other stuff that followed afterwards, I am going to talk about what we did subsequent to our exploration of surgical buy-in, which is that we started audio recording conversations between surgeons and patients because surgeons had told me that they had made a contract with patients. That when we talked to patients about surgery, it wasn't just about surgery, but all the other stuff that came afterwards and they had agreed to it. And I was like, huh, I'm a surgeon. I don't really do that. What are we doing? And so when we started putting audio recorders in the surgical clinic, trying to listen to these preoperative conversations, we came up with some really interesting data. And indeed, surgeons don't really make this contractual plan with patients, but on top of that, after we listened to these conversations, we interviewed patients both before and after their operation. We found that patients had very different impressions of what was going on in these conversations as well. And when we talked to them, they said things like this. When I went and talked to the surgeon, I felt that surgery had to be done. There really was no choice. We did it by and large because he said, well, it needed to be done. And there weren't any other options. They also noted that recovery was much harder than they had anticipated. And now, even though the surgeon had disclosed multiple disarticulated risks of the operation, they were pretty shocked that the recovery of surgery was so challenging. And then finally, they were very clear that there was never an opportunity to talk about what would happen if things went poorly. That especially in cases where we did interview family members for patients who had very severe complications, including death, they really didn't know what to do after surgery because it'd never been addressed before surgery. And this is what the state looks like. This is a neurosurgeon in one of our earliest studies, and he's talking to a patient about tumor resection. And very appropriately, he goes through all the risks of surgery. And I would say he does everything that we've been taught. What questions do you have for me? And the patient would say, well, washing my hair. And the doctor very appropriately says, well, you can use shampoo, but don't scrub the stitches.  And what we noticed when we saw all these questions that patients were asking is that they wanted to ask questions, they weren't quite sure what to ask. And in my lab, this gets coded as logistic and technical concerns, that while these questions may seem really important in the moment, they actually don't help patients figure out what are the options, what's it like to have surgery, and what's the recovery gonna be like, and what would happen if things went poorly? How might you know my wishes? So we sat down with a group of patients and families over a year went through all of these transcripts looking at the patient-doctor conversation. And what we came up with was an intervention that's called a question prompt list. It's pretty simple, it's a brochure, it's a little trifle brochure, and you can see that the brochure has three elements. The first element is really this issue of options. And it's not just what are my options, but what is surgery gonna do for me? In your opinion, do you think surgery will help me live longer? In your opinion, do you think surgery would help me feel better? The kinds of questions you might wanna ask your surgeon in order to figure out if surgery is right for you. The middle panel is really about what to expect. These are expectations when things go as well as we could hope for. Am I gonna need lines or drains? Is this gonna change my other health problems? What kind of care am I gonna need after surgery? And then the last panel is really about advanced care planning. How will you know my wishes if I can't speak for myself after surgery? So we applied to the government and they gave us a ridiculous amount of money to study a paper brochure. And this is our conceptual model of what we were trying to do here. The idea of our intervention is that prior to surgical visitation outpatient, we would have the surgeon send the patient and their family a letter. And the first is a letter from the surgeon saying, surgery's hard. And when you come to see me, I want you to ask questions. And here's a list of questions you might ask. And we included the brochure. And the idea in the literature is really this idea of patient activation. When you prepare patients for decision making, they may have a better time. So our primary outcome of our study was what questions did they ask? Do we change the questions from these ideas of logistic and technical concerns about stitches and staples and shampoo to questions about should I have surgery? What should I expect if everything goes well? We also had some other outcomes, including surveys of patients and family members after they met with a surgeon, which are really sort of how self-efficacious do you feel in your patient-doctor relationship. And then finally, we used a measure of shared decision making, which is observer measured, meaning that we audio recorded all of the conversations from patients in our study and then used this observer measure of shared decision making to calculate whether we improve shared decision making. So we did a multi-site randomized clinical trial using something called a step wedge design. And if anybody wants to talk about a step wedge design, I'm more than happy to do it with several vodkas in hand. It's really a very painful way to run a study, but the idea is that you randomize surgeons over time to when they're gonna take on the intervention. So every surgeon is in a pre-post study, but their pre-section is gonna be a little bit different than their post-section dependent on your randomization pattern. So we did this at five sites across the country, Oregon, San Francisco, Wisconsin, Boston, and Rutgers in New Jersey. And we had 40 patients, or sorry, 40 surgeons enroll in our study, and they all performed high-risk surgery, so neurosurgeons, cardiac surgeons, vascular surgeons, cancer surgeons, colorectal surgeons, GYN oncology, and urology. And the patients we enrolled in our study had to be at least 60 years of age and have one or more comorbidities.  It's a totally negative study, which now I need a support group for people doing interventional studies. But it's really sort of very interesting to look at the data. So when we looked at these questions that people were asking, we did see some movement in the questions with our intervention. So I'm gonna go just talk about this first outcome of question asking. So when we looked at options questions, you might note the light gray bar is the intervention group, the dark gray bar is the control group, and that we were able to very gently move the numbers of questions asked, reducing the zeros and increasing the two plus. You'll also note that some of the p-values I'm gonna show you look statistically significant, but they're not. And again, this death by math thing is really very frustrating when you run a study. If you study multiple outcomes, you have to use a Bonferroni correction, which reduces your p-value to the point where we did not see statistical significance. But I think what's most interesting is I run you through these questions that people ask. These are expectation questions. Is how many patients didn't ask any questions about what to expect after surgery, or what options they might have besides surgery? And here's the issue about risks. Very few ask questions about risks at all. So even though this was a really frustrating study, one of the best things about the study is that we audio recorded all of these preoperative conversations, and we have real information about what occurs since we enrolled 450 patients into our study. This is our issue of shared decision-making. So this option five score is a score invented by Glenn Elwin at Dartmouth, and it's a nice way to try to discern whether shared decision-making is occurring. We did see some movement in this score. I'm not sure how great six points is. Again, the Bonferroni correction makes this non-significant, but it's interesting this idea of thinking about what are the domains of shared decision-making and how might we measure it? Because when you survey patients and clinicians after encounter about shared decision-making, you get very different results than you do when you actually count up the domains of shared decision-making and see if there's a real difference in the moment. So I'm gonna talk just a little bit more about the question prompt list and then talk about the exciting data we found with all these audio recordings. So is this enough to consider routine use of the QPL? So it's pretty low risk, it's very low cost, and we found that it didn't change the visit length. It's really just a piece of paper. But I think the most important thing that we found is that questions about options, expectations, and risks are not often asked, and you might note that I didn't even show you the advanced care planning data, and that's because we saw only 13 questions about advanced care planning in an entire study of 450 old people considering major surgery with multiple comorbidities. So that is a huge problem to not think about advanced care planning at all in these conversations. I'm not sure QPL's gonna solve that problem, but clearly it's a big issue. The surgeons in our study, we sent out 6,000 of these QPLs prior to the clinical visit, so we didn't know who would be enrolled, so we sent it to all of the surgeon's patients, and the surgeons really liked it. They really wanted to continue using it even after the study, and maybe we made some movement on shared decision-making. So what else did we find? We found that there was huge variability in the use of shared decision-making in our cohort. In fact, there are really some high performers in the surgical cohort by surgeons who really do actually spend quite a bit of their effort in the pre-operative conversation doing shared decision-making, and then there's a very clear group of low performers. Remarkably, the surgeons, the high-performing surgeons have great variability in their use of shared decision-making, and they seem to employ it selectively, either when there's real clinical equipoise for something like a uroostomy versus an ilial loop conduit. There's clear notions about patient preferences around those kinds of operations, or when patients were very, very high risk, and they were worried that the outcomes of surgery were suboptimal. The other thing we found is that the patterns of pre-operative communication are incredibly robust, and I think all of us do this incredibly consistently, that we start with this explanatory phase where we talk to patients about their disease and we talk about their treatment. We say things like, here, this is you, slice-like bread, this is you in a CAT scan, and this is your liver, and this white spot in your liver is a tumor, and then we say, and I'm gonna take it out. And I think that the way we've been taught to describe surgery and its consequences and to get informed consent very much revolves around this notion of generating patient understanding of their disease and the treatment, and the problem with that is that we use a lot of fix-it language about what the problem is and how we might repair it. As a vascular surgeon, you might imagine I say, here, here's your blockage, and I'm gonna do a bypass and go around it.  And I wonder if we're not setting people up for real harms because it's very challenging to think through that deliberative part of the conversation. Once I've told you this is the problem and this is the operation I have to fix it. On top of it, the other thing we saw in our data is something that looks much like this, and I'm just gonna put it out there that we had a competition to find the worst case of this and maybe this one, one. But this is actually pretty typical of our data, is that the surgeon does this fairly long monologue, trying to describe to the patient what is gonna happen with surgery. And it gets a little bit to this point about transparency and what do people need. But this is a surgeon who is working really, really hard to describe a Whipple operation, which is a removal of a pancreas cancer.   I am not sure how patients can use this type of information in order to figure out whether surgery is right for them. It's as if the plumber came to your house to fix your toilet and the plumber spent tons of time explaining all the little gizmos and the things in the back of it and what were broken and what he was gonna do in order to fix your toilet. And never told you how well your toilet was gonna work afterwards, how long it was gonna last, and what it was gonna cost you. Because at the end of the day, as much as I can imagine, some people wanna understand how their toilet works, not everybody wants to know how their toilet works, but everybody needs to know how much is it gonna cost, how long is it gonna last, and how well is it gonna work. And if we spend most of the preoperative conversation doing stuff like this and forget to do that other stuff, we've really misled patients. And so when we went through our data and we looked at how often surgeons talked about the goals of surgery, what was the aim of the targeted objective of the operation, we found that over 50% of the time in these preoperative conversations, the only goal mentioned was to fix the problem. And the problem with this is that if you tell patients that this surgery is gonna fix your problem, then they will attribute whatever they want to the fix of that problem. Many years ago, they did this brilliant study in the UK, which I guess they could do because people sat around waiting for their carotid endarterectomy, but they interviewed patients before carotid endarterectomy, and the only thing that operation does is prevent stroke. And they interviewed patients and they were very good at describing the risks of the operation. And then when they asked patients what they were gonna get out of the operation, they said things like, my memory is gonna get better and the ringing in my ear is gonna go away and I'll be able to see better and my headaches will be better. The problem with using this fix it notion of what we are doing when we're doing surgery is that people will attribute whatever they want to the fix without understanding the real reasons for pursuing surgery. I suspect many of you have seen this video, but if you haven't seen the video, I'm not gonna play it. It is hilarious. So if you Google orthopedics versus anesthesia, you will get this video and the little blue bear with the blue stripy shirt is the orthopedic surgeon and the red and white stripy shirt is the anesthesiologist. And the orthopedic surgeon says, I have a fracture. I need to fix it. And the anesthesiologist says, where's the fracture? And the orthopedic surgeon says, it's in the emergency room. And it goes on and on and on and on. And the reason this is funny is because it smacks of truth. And it's not just because it's so easy to make fun of the orthopedic surgeons. It's because we all do this. We're working really hard to generate understanding of disease and treatment. And I worry that we have taken this way too seriously and misled patients and don't actually supply them with the kind of information they need. So the next step in my lab is to try and revise this pre-operative conversation, but we're not there yet. Anyway, that's all I have to say. I wanna thank my amazing lab. This takes a ton of people to get this kind of work done and I'd be more than happy to take any questions. Ah, Giuliano. Hi, Giuliano Testa from Bailor d'Alesson. This is a great thing. I have a couple of little problems. One is probably, there is a lot of male mentality in surgery. And that's when I talk to my wife, she has a problem, and she says, I'm gonna fix it. I don't want you to fix it, I want to listen to me. Which already is a problem in itself. After so many years of doing surgery, and what I'm gonna ask you is, my impression is that no matter how simple you put it, no matter how many data you put on the table, no matter how long you explain, the patients very often don't wanna know many things. They really won't have the problem fixed. I mean, that's at least has been my experience as a surgeon. What would you propose with a different way of approaching this? You're not gonna approach a problem of the toilet telling somebody it's gonna cost you a lot of money and not telling whether they really need the toilet fixed, which is the bottom line of it.  Giuliano fixes things in a way that I just rearranged the deck chairs on the Titanic. So I actually think that there are things that we could say to patients that any patient could understand and that actually really they need to hear in order to figure out whether to have surgery. And so it's two things. One is talking about outcomes. Surgery does four things. Maybe live longer, feel better, make a diagnosis or prevent disability. If we don't mention one of those things in our pre-operative conversation, we've really failed people. And the other thing that I think people can completely understand is this idea of a trade-off. That surgery might help you live longer but there's a real trade-off.  And I think the problem is that we haven't distilled this conversation into this space of what are we trying to accomplish and what are you willing to trade-off to get there? And I don't think talking about the risk benefits and alternatives is doing that for us but I think we could have a different conversation that would get them there that everyone could understand that is not about fixing problems but it is about achieving certain goals that people are willing to actually expend a fair amount of time, physical distress in order to achieve. I don't know whether it is because I did the fellowship or because I've always been this way but I think I approach the conversation with my patient exactly as you say but so you think it's a widespread common behavior from surgeons to ignore the second part? So this is the best, no, so I think surgeons do the second part but this is the best thing about showing up with data I have 450 conversations that look like that. Okay, Peronner, Chicago, soon to be Kalamazoo. Gretchen, this is amazing work. I think you're really revolutionizing the whole concept of informed consent, taking it away from sort of the mechanical procedural aspect which many people tend to fixate on into what is really being offered and the real benefits and risks. I think the data you presented of that turn that the surgeon take is incredible that somebody could talk so long without having any feedback from the patient and it really points to the fact that people really aren't having conversations. They're having monologues and I think one of the basics things is people will need to learn is how to have a conversation in which there's turn taking and which there's a back and forth. Yeah, I mean I think we're working really, I mean so first of all it's easy to pick on the surgeons A because I have data and B we probably bring it on ourselves a little bit but I think other people who have audio recorded conversations between clinicians and patients very much see this sort of same notion of this is your problem and this is what we're gonna do to manage it. I think it happens in the ICU for sure it happens in oncology clinics and I think that oftentimes when I'm giving this talk I say things like I blame the bioethesis and I don't mean the people in this room I mean sort of bioethics as a group that came up with this brilliant idea of informed consent in the 50s and 60s and then never did the empirical work to see how it was playing out in clinical practice in order to sort of revise and innovate and make it better because I do think that what we're doing is exactly what we've been taught to do generate understanding of disease and treatment and that I think is very flawed. I don't have a problem with the second part of the conversation I just think that it's what are under the bridge at that point. Well it also brings up the question of I mean the people have got very technical and I think a lot of surgeons consider them are very you know they're good technicians and they know how to do the operation but questions about you know what the values of the patient and will they actually benefit and what ways will they benefit those kinds of questions very often the surgeon don't even ask themselves so I think to ask them to have that with the patient I think is difficult. So Daniel point about what is the benefit of this operation is a really important one and I'll often start an operation saying to the med student or the resident why are we doing this operation and they'll say something like there's a blockage it meets criteria the ABI is low and oftentimes I will have to ask that question three or four or five times to get to the point of make the patient feel better help the patient live longer prevent limb loss you're a spot on about that. Thank you. Hi I'm Neil Fine I'm a plastic surgeon at Northwestern and I enjoyed your talk. I think though I didn't hear you say specifically some ideas about people understanding probability because when my patients were mostly women with breast cancer are asking questions like when what's when will I be recovered or how will I do? I find that I have to try to tell them well I can tell you what's most likely are common but I will have a hard time telling you exactly what's going to happen to you. I do this operation hundreds of times and I will get a very diverse answer from my patients about how they're recovering and how they're doing. And so the whole idea that someone wants to know for instance am I going to live will I die in this year? And you say yeah you're gonna die this year but I didn't I live for 10 more years so you lied to me versus you can live for 10 more years but I died next month. Yeah so I'm gonna direct things. Yeah so I mean I think this issue of uncertainty and how we describe that with patients is really interesting and very important and I think we shouldn't hide behind it as a reason not to do things. I'm gonna send a little Elizabeth Warren like here but I have a plan for that. That is my surgeon mediated intervention and also equally challenging to study but I have a different intervention for that. Well I talked to them about what I tried to tell them is you're gonna ask me this question and I'm gonna tell you what's most common and I'm gonna try to tell you what the ranges are. Yeah so I'm gonna put a plug in for my other intervention it's called best case worst case. Thanks.


all welcome to the 42 courses podcast. For those of you that don't know Rob, he's one of the most incredible, most awarded marvellous strategists in the world, currently based in Auckland in New Zealand, but originally from Nottingham, which is not a million miles away from where I'm speaking from you, speaking from you, speaking to you from, so, also excuse my dyslexia, I'm going to get all my ways wrong. But Rob, welcome, I'd like to have you on the show, really appreciate you taking time out. Well, thank you. I mean, that was a better introduction than I would ever get from anyone. So thank you so much. And thanks for having me. Let's hope I, you know, don't make you regret it. No, no, no, gosh, I mean, you know, I'm looking forward to it. We were just having a quick catch up before and Rob said that he was immune from maturity. So I think this is going to go absolutely perfectly well. I mean, maybe, maybe we can start at the beginning. I mean, you've had so again, if you haven't, if you don't know Rob is literally when I say he's incredible, he really is incredible. But you've worked all over the world, you've worked for some of the most incredible agencies, worked for some of the most amazing brands. How on earth did you get into advertising? Like, was this was this very natural?  Yeah, no, no, I mean, it was like, I wanted to be, when I was a kid, I wanted to be a policeman, which would have been a disaster. And then I wanted to be a rock star, you know, the usual thing. And I was a student musician for a long time. And then I just, I fell into advertising. It's quite interesting because I'm always deeply suspicious of people who just want to work in advertising. Because I always feel that they're forgetting, like for me, I'm a culturally led strategist. I love culture, subcultures, basically, and how creativity can really impact that. And yeah, so I kind of just fell into it. And to be honest, that's probably the best way it could happen. I was a shitkicker, basically, and a litter tray and just like real bottom stuff. What I liked most was that I didn't have to wear a suit. That was probably the greatest thing for me. And that's because my entire family are from a legal background, but in a really, like my mum, my mum is Italian, well, she's past now, but she was Italian, all her family were lawyers against mafia. My father, he was a human rights barrister, like you see. And so me getting into advertising was basically the occurrence of me being, I don't know, a crack addict probably for them. Even when I was a musician, you know, they were always supportive. But yeah, no, I just fell into it. And then I got to meet amazing people. And I think that's what's kept me going, honestly. I've just been always open to stuff. What might it be open to anything, then everything can happen. And I've just been like I love Nottingham. I'm proud of coming from Nottingham. I used to think Nottingham was the greatest place on the planet. And the life that I've been able to enjoy is beyond comprehension. But I'm not finished with it yet. But just living in China, like at school, when I was young, I'm old now, you never learned anything about China. China was this invisible country. I spent seven years of my life there. My son was born there. It's the most special experience of my life to this day. So yeah, I fell into it. But I keep saying, where people fall downstairs, I kind of fell upstairs and just somehow managed to keep doing stuff I found interesting and stayed in it. When you say you fell into it, I mean, did you meet someone? Did you go to London? No, my dad had a friend who was involved in advertising who said, oh, you should think about it. So there was an element of like nepo by proxy in some respects. But then, yeah, I was at a name school, Hal Henry. And I didn't know anything. And that was the starting point. And then it was just was a journey of individuals rather than agencies. I suppose the first agency I went to where I mean, Hal Henry definitely had that aspect. But the first thing to where I really felt there was a culture, not the bullshit, contrived, like annual report stuff that they write, but a real culture was at Wynan Kending. And that was where I felt the agency was bigger than the individuals for the first time. And I'll always be a child of theirs. It's, yeah, it'll always be very, very special to me. And I've worked at lots of places, but I'm like cleanser. I think cleanser is some sort of, I don't want to recreate Wynan Kending, but there is naturally a bit of that feel here. But I, yeah, I do feel I like families, but I like families who are disruptive rather than just they lie to each other to keep everyone happy. And where I've, where I felt a thrived have been in environments either because the company's got that culture, which there aren't that many, or those individuals within it that cultivated it. And I've just been immensely lucky in that journey. It sounds like you so it's the people that the agencies and the culture of the agencies that you were attracted to. And you didn't mention it, but I'm sounds like maybe you found some amazing mentors as you went ahead, whether you called the mentors or not, but sort of sounds like you've met some amazing people who inspired you in certain ways and helped you onto the next journey. Is that right? Yeah, I mean, yeah, it's funny.  And some of them I'd worked for on some of them I just met, but their advice was there. And it was amazing because nobody responded to me. Jesus Christ. And I spoke to one of them and they basically thought I had a terminal illness. And I was saying goodbye to them. But I've got I've have a lot of people have made a massive impact on my life and my career. And I have two that I rely on quite a lot for advice. One's an ex boss, one's an ex client. And they're proper mentors, because I know that they want me to succeed. But they will give me the ultimate gift of honesty. So and they've been really helpful, really helpful. But I have a lot of people that I talk to and listen to and value the opinion of. But I've also I'm driven by my gut a lot as well. So so yeah, it's a it's a mixture. It's certainly not I used to live with somebody in Australia as a flatmate, Holly, an incredible human. But she had her career. She was a different industry, but she had her career mapped out. And I used to look at her with like, both admiration and just confusion, because I couldn't work out how that worked. Because for me, yeah, I've always I've always gone where I feel excited and challenged versus a more linear career path.  So there was a time at Wyden where they, you know, started talking to me about what I like to be imagine director.  And that'd be a terrible number one. And so yeah, I've been surrounded by people who've had that, sorry. Why do you say that? Why do you say you'd be a terrible because because my goal is I want to look after the quality for me, get to the best work possible. And then the people win. But I feel that if you're a CEO, there's a lot more things you have to take on board. And I'm pretty simplistic. And so the idea of doing that, having all these different people that you have to manage all this, it's just, I get to tell clients, colleagues, whatever the truth, the real truth, not honesty, truth. And there's a big difference. And I don't know if as a CEO, you could get away with that because not because you're lying or anything, but because you have to have a much more sensitive, greater sensitivity to a bunch of different factors. And for me, I just run after the most exciting work and being a number two allows me to do that with way more freedom in my mind. I think you had your own company. You could you could say what you want, whatever you want. No, I did have my company. And my partners also said I wasn't allowed to talk about money. And I definitely wasn't allowed to talk about money. But yeah, I mean, I do, but I also have my other side of life where I work with a bunch of musicians and fashion royalty. And but that relationship is different because they've asked me to be part of it. Right. So I'm almost like a partner rather than an employee.  But it makes me feel happier in that position. Makes sense. And how did you end up in China? You were there for six years, you would say? Yeah, seven years. They, well, both BBH and Wyden asked me to go there. And so I went, I'm not a particularly spiritual person, but I went, that's a sign in typical. And also the other side of it was going, no, it was BBH or Wyden, you go, well, you can't lose. It wasn't the most. Secondly, China was the most economically influential market on the planet at a time when the world's economic situation was in dire, dire straits. I went, why would I not do that? I've always gone to where the excitement is. Well, because all my mates said you're mad. Wyden and BBH is China, you're mad. And it was the most, yeah, it was just one of the most pivotal times of my life, personally and professionally. And as much as China has many things wrong with it, as does every other country, I will fight for that nation. Fight for it. It's misunderstood. It's subject to incredible corporate arrogance and prejudice. And yeah, I love it when people come out and they go, well, look at this, like, even with the situation with TikTok, there was no way that if TikTok had been created in America, it would have encountered that level of prejudice against it. And there's no way that America is this like, wonderful, hey, we're all good. We never do anything wrong. I just find the hypocrisy in it. I'm not saying China's perfect, but my God, neither is the UK. And yet there's this arrogance and ignorance that goes around. And so for me, the greatest gift with Japan, China, Hong Kong, Singapore, those nations is that, yeah, I felt that I got to be an insider and an outsider. And that was an incredibly rewarding and creative period of my career. I must give you some incredible insights as a strategist to be able to learn from so many different cultures.  I've always thought that travel broadens the mind and the ways of creativity is a combination of different things. Traveling has got to be good for you. And I'd imagine saying somewhere for an extended period of time must have been really helpful for you. Are there any key things that you've learned that made you really go, like, oh, okay, from some of the different countries you've lived in? Honestly, I mean, everything I thought I knew in China was different from filial responsibilities to the education system, to the issues of success when you've come from a nation that in its memory can remember the absolute worst of possible times. Yeah, there was a huge one. I mean, but what I also find, there was one guy, so I was working with Nike at the time, and sport in China was loved to be watched, not necessarily played because sporting system has a lot of challenges. Let's put it that way. And someone said to me, which I love, and she said, well, maybe China has gone past the sport thing. Maybe it's not a case that you're trying to take them to where sport is. Maybe they did that 2,000 years ago, and they've just moved on to the next thing.  And just that context of what is context? What is life? What is time? What are the aspects? I always thought when I lived in the UK, and it's fascinating that we did campaigns for England, when Nottingham and Derby, 15 miles apart, have very different ways of translating certain different meanings, whether that's from language to literally life choices. And yet we retreat England, I think. So China blew my mind, you know, or when you had global campaigns, I was like, whoa, have you designed that? Have you designed that? So I remember doing a PG campaign. And I wrote this thing, which was, in America, if your child loves sport, you'll drop them off at 9am and pick them up at 1pm. In China, if your only child is identified by the government as having sporting capability, you might drop them off at 9am and pick them up four years later. And what was interesting is that was when Tiger Moms were a big thing, and just the prejudice and the ignorance came out. And the sacrifice of love, and for the West they would go, how could you do that? But in China, there's a whole different context of it. And for me to have, to be let in, to have a greater understanding was incredible. But by the same time when I lived in America, I mean, I talk about them a lot, but Breyer, Meyer and Chelsea, three African American women, changed my life. Fundamentally, genuinely, fundamentally changed my life. And their generosity and helping me understand the intricacies of the racial conflicts in America. I mean, again, you know, that's a Western market that people think they know. And a lot of people who look like me don't. So I think the point of me travels, I agree with you, travels amazing, but you've got to want to learn. I met this guy in China. The first thing they said to me was, do you know where you can get this Belgian cheese? And I went, Belgium? It's like, like, and it's like, and of course, in China, you probably could get it anyway. But it was just this attitude of I wanted to recreate the life I had in Belgium in China. I appreciate some elements to that. But why would you not want to embrace it? And like in America, I was very fortunate with those three brilliant humans and others like, well, a whole bunch of magic. But you've got to want to want to learn. And that's why I find it really frustrating when I hear strategists talk about curiosity, because what they actually mean is curiosity with a level of privilege versus curiosity with a level of culture. Right. And when you were mentioning about the Olympics, did you you want some awards in you for the Olympic ads? Was that the PNG work that you did? Yeah, yeah, yeah. That was, yeah, thank you, mum. Was that one of the insights that you came up with? As you were saying that, I was like, yeah, we did that. That was part of it. Yeah, especially as I said, because the Tiger Mum thing was going on.  If you don't understand context, I understand why that can look brutal. But you know, some of this, they didn't even have a choice. Like it was a government decision. And there were a lot of people involved in that. But the work we did across Asia Pacific, yeah, it was great just to find out what it's like to be a mum of an athlete. It's so different. Like imagine you're the mum of an athlete in a sport that's never going to get worldwide acclaimed, but the government have said, you're really good at it. Like in that culture, a lot of children end up being almost like a this is a terribly crass way of saying it, but like the pension scheme, they will look after the family. There's something quite beautiful. It's almost, I was equated to the Italian side of that as well, the family. If you see your child following a career where you go, they're never going to be financially successful, but they're doing it. There must be so much complexity and internal turmoil. And yeah, we wanted to highlight that because I think mothers in particular would connect to that once you, you help them understand it from a family perspective rather than just the, the outward cliches of it. Yeah. So I love that. I've got a lot of the films that we did to prove a point that obviously was just part of the creative journey. And I remember going home actually. So with that thing about you picked your kid up for years later, we went across China and spoke to parents who'd done it and the challenges they had of just wanting to love their child, but they know they had all this challenges. I showed it to my wife. My wife said, the Canadian Aussie and she cried and we didn't have a notice then. And I was like, okay, well, if it's connecting to her because of the content and her context is so different, then we got to the truth of stuff. That made me, yeah, I'm very proud of that stuff.  Like, congratulations. It was a small cog, but yeah, it's wonderful. I mean, when you, you've worked across again, lots of different brands, lots of different places. Is there any kind of playbook that you have in, you know, for yourself when you, when you, I guess, there's a couple of things that were going through in my mind. One of them was, you know, when you go to a new country and you start a new agency, are there a few things that you always do that helps set yourself up for success? And the second one was, when you're sold, okay, Rob, please, can you help us on a certain name of brand? Are there a few things that you try and do again to set yourself up for success and that? So I guess it's kind of too separate, but possibly slightly. I mean, when I moved to a new country, first of all, it's, it's no that you don't know. One of the worst things is when you try and post-rationalize something through a context that you understand. So skin whitening cream, okay, one of the worst, worst possible cultural jail products ever made in man. And I remember talking about the harm it had done for women from the Asian markets and how it basically it was a cultural jail. And part of that is somewhere deep, deep down in history, there's a belief that if you have white skin, you come from a family that didn't have to work in the fields. And some companies have exploited that for financial gain. Horrific. And then I was talking to somebody in the UK about that and they said, oh, it's a bit like some fake suntan lotion, isn't it? I said, what do you mean? They said, you know, people want to put fake tan on so they look healthy. And I said, no, no, I appreciate from your context that might look quite similar.  And but I saw that all the time where people took their concept when I moved to a country, it's like, understand their context versus trying to understand, but put it through mind, actually put the effort into want to learn. That's a big part of it and expand your references for who you can learn from. So I often work with, I often go to police stations straight away and just hear about what, like what petty crime I talked to late night radio hosts, I talked to teachers, a bunch of different people, I just don't meet people. And then I get, I get a soup of possibilities in there versus just one person. But you have to want to do it and make the effort. But trust the people around you and hire really well. And you're sure the police station thing isn't just you harking back to your childhood? Yeah, maybe.  But even when I came to Auckland, you know, I spoke to the police and what's there? What's part of the issues of crime? And this cop has said to me, kids are bored here. And that led to us doing a book called Dream Small, which was a research project. I sent some planners and a photographer across New Zealand and just walked the streets and talked to people. And it definitely that definitely proved out to being part, well true, but with other aspects. And then as regards problems, I mean, my biggest thing is like, what's the actual problem versus what do you want the problem to be? And then as I said, I am culturally driven. So I want to know what the subculture is that's the most influential in what they're doing. And if they recognize it, and then find out what the tension is and where they could go. Because I am a big believer that when you talk to a subculture and you understand where they're going and you liberate that, they actually act as a beacon and a magnet to pull broad culture up to it, versus just talk to as many people as you can. So in New Zealand, there's only five million people here. So there's a mentality, you can talk to everyone at once.  But being able to communicate to everyone at the same time doesn't mean that you're connecting to everyone. But there's this attitude. So for me, it's like, well, who are actually do we have to talk to versus who could we talk to? And there's a big difference. And some people don't agree. And that's fine. We'll never be good people. I mean, I'm at a point where, which is really arrogant, if I think about it, where I haven't got the patience all the time. I appreciate the other ways of working. But this is my way of working. And an example, I love what you were saying with that, like finding the subculture.  Well, yeah, I mean, I mean, even if you, okay, so let's talk about sport, just because it's universal and everyone can reference that. Just because you watch football doesn't mean you're a footballer. It means you love watching football. In fact, most times you love watching a team. But that's very different to someone who actually is an athlete or thinks of themselves as an athlete. And the issues and the tensions and the concerns that they have, what their will is. But if you're watching it, I love Nottingham Forest, I get up on godly hours, I fly to the UK when it's a big, I'll do all that. But that's very different to someone who's getting up and playing a game and facing the challenges and where every aspect of it affects their life from the fashion they wear, the clothing, the programs, the films, the music, they hear things, they see things differently. If you ignore that, you're just talking at people. If you embrace that, you're doing things for people and speaking as an insider, not an outsider. And a lot of people can think that that's a lot of time and energy wasted. But the most powerful brands in the world have a clear position in culture that are talking because they are part of the culture. They're not trying to buy in and they prove it by their actions. Anyone in, it's a bit like in the 90s when agencies tried to show kids with a baseball cap back to France. That was the, that's, hey, I'm a skateboarder type thing, you just go. The only people you're fooling are the people who are fools. Yeah. So a lot of it is nuance and details. But yeah, I'm a big believer in understanding that I have people who are part of that culture or younger than me because obviously I'm too old. But yeah, I take a great amount of effort. We're working on a range of projects at the moment where when we've said to them, we appreciate that's who your audience is. But the people who influence that the most in this group and we need to understand the behaviors, we need to understand them, not get answers from them, understand them. We spend a lot of time like that is my, that's part of the identity in my planning department. That's interesting. And maybe I was, maybe that was a small thing that I, maybe I'm not understanding that, but I loved what you just said that you said your target audience is not necessarily your target audience, it's the people that your target audience are influenced by. Yeah. Right. Amazing. Like, so it's very rare that you hear someone say something like that sort of simple.  And I don't know whether this is part of it or not.  Is there any way you can share a little bit about that and your thoughts of, you know, what explain that? Well, I just feel that people care about what's important to them, not what we want them to be important to them. And in our quest to, I just feel that we've become so formulaic, honestly.  And yet the, and yet if you look in culture, so much exciting stuff is going on. And because they're more open to things. I mean, even let's talk about succession. You look at how succession is written and the role of the writer's room. The writer's room is basically anything goes if they think it's really exciting. You wouldn't get that in advertising structures. Advertising structures is logic. It's been advertising is in danger of only looking down to move forward. But the things going on in culture that are exciting, whether it's Cortez, whether it's succession, whether it's what certain video games or whatever, they're looking up and taking leaps. And they're taking leaps and people run and follow them. I mean, if you look at a brand like Gentleman's, I'm quite lucky I get to work with those guys. You know, they're an eyewear company. But if you saw them, the way they take what they do and how they do it, and they're kind of like an engineering company at the same time with tech and the future. And I did some stuff with SKPS, which is on the edge of a university when you're in the is the most profitable luxury street culture retailer on the planet. And it's been designed to feel like you're on Mars, like just incredible stuff. You would never get that following a lot of the, well, the vast majority of advertising modeling. And I get it, marketing is expensive and there's a lot of risk involved. But in the quest to minimize risk, the other side is your minimizing potential. And I, I work really well with clients who have a chip in their shoulder and want to change stuff rather than communicate stuff. And that's why it's very clear the clients that I'm really good at. And the clients I'm a nightmare at. And it's, it's fair to say that it's not about a particular category. It is an attitude and an ambition that drives me. So I know, I know what I'm terrible at, and I know what I'm good at. And now it's been going on for so long. I've lived in so many places. I've got, I've got the sort of clients that know who I am and what I do. And the ones who wouldn't touch me with a 10 foot large pole. And I'm comfortable with that. I don't, I don't have to prove that I'm not saying that they're wrong. The people who we had a different, I'm not, but I equated to, well, someone of the ones said it, they said to me, you follow a different religion. And it was quite a nice way of saying it. And I went, yeah, I do. So what, I mean, there's lots of stuff going on. I mean, we're, we're recording this and it's sort of probably a month and a bit out from, from Cannes. Lots of work coming out at the moment. Are there any things right now? I don't know. Off the top of your head, can you think of like three brands that are doing good work or even one? Or can you think of maybe, maybe three where you're like, what on earth were they thinking? I mean, the vast majority sometimes I think are what are they thinking? Or well, I know what they were thinking. I was just, I just think a lot of it's quite lazy, obvious stuff. Like there's a huge disappointment with the airline industry. There's so much potential with that. I've worked with one in particular for a long time. They've gone through a lot of change and I've seen what they've done. It's just, and I know that market's particularly hard, but it's also an amazing opportunity for them. But yeah, I think, yeah, for a general answer. Just really quickly while you're on Virgin, I read something that you said that, again, I think it was in one of your blogs and I thought it was so amazing. Well, two things.  And the second one was... There was an insight for the lounge, which I thought was amazing. Make people want to miss their plane. Yeah. Love it. But that was from Branson, to be fair. But yeah, I mean, just the articulation of, I mean, it could have been create a lounge that capitalizes on the values of the Virgin Atlantic brand and reassures business customers that made the right decision. Or make people love the lounge so much they'd rather miss the plane.  Love it. It's just got a different energy. And that's someone who gets who they are, what they do. But who are brands that I think are doing interesting stuff? I think Palis are really interesting.  But street culture, I think, is phenomenal in itself because it's become, it influences like high end luxury. As I said, STPS, Mr. Jean, most profitable luxury street culture brand on the planet. I find that sort of thing. Yeah, I find that sort of thing really good. And there are brands that are much smaller, who I find really interesting. And as I said, I find the gaming community also interesting more for, well, some members of the gaming community, more because of their bravery in that sense. And then I look at Cortez, which a lot of people don't understand how they've achieved such like a momentum against street culture brand. But again, they've done a deal with Nike and Nike. I'll always love Nike. I spent a long time with those guys. And I still think that they're number one. But then I can look at Metallica. You know, it's a niche brand on one side because of the music they play, but they're the second most successful American group in musical history. And because of the way they expand. So there's lots of stuff. Nobody wants to be inauthentic. But I think those that have realized that by being vulnerable, you can be even more authentic and you embrace it, they excite me. And that's why for me, I love creativity more than advertising. And I love subcultures, more than just women 18 to 59 or 54, I should say, just because I think you find out, you find out stuff that you go, wow, you find out the tensions they're going, you see the opportunities where you can, where everyone wins, or you try to do it.  A lot of brands don't have a strong point of view. And for me, that's when it gets mucked up. I'll tell you a brand I really like at the moment, Kia. I just think like there was a lot of talk that their logo, you can't, nobody knows what their new logo says. And I'm like going, and they're saying it like it's, oh, so it's wrong. And I go, well, one, it's not that hard to find it if you wanted to know. But two, the design of the cars, the way they've looked at it, that the whole they found, they found their voice. For me, I think they found their authentic voice, and they're really interesting. I'm really interested in what they're going to do. They're challenging conventions. They're not doing it for just, you know, some of the brands in the past have been a bit Samsung-y where you've added stuff just to try and look different. But they're, yeah, I'm really quite fascinated by Kia at the moment. I'm really interested in what happens. Again, their choice of designer has made such an impact. But every aspect of it, and we're getting into all these rules where you go, by reckoning Kia shouldn't be successful, Metallica shouldn't be successful, Gentle Monster shouldn't be successful, Cortez shouldn't be successful. But they are more successful, more sustainable, and have a disproportionate impact. Like Liquid Death, then a lot of the brands who are very established. And that to me is fascinating because we're not going to grow if we just place such markers on what can be done that we, yeah, that we never get a chance to do it. Because culture knows what it wants, it doesn't know how to articulate it.  And it is, I think they made 130 million last year turnover, which is nothing. And Coke, Coke made, I think, $25 billion of profit over $4 billion of marketing. It's an incredible return investment. But, look in the numbers of Liquid Death a bit more. And proportionately, the impact they've had on culture and the awareness, far exceeds Coca-Cola. That's not saying, I think Coca-Cola finally got back a bit on track.  Don't tell me that that model doesn't work. I'm not saying that it's more successful than Coca-Cola, but for return investment, it's got a better one. So let's look at that as well versus just this very, a lot of people playing at being business people, rather than being understanding business. Incredible examples. And I agree with you on Kira as well. It's phenomenal watching that company turn around and what they've been doing. And there are any brands that you absolutely love, but you're like, oh, God, guys, what are you doing? Come on. My brain always goes like, I mean, I don't love them because I have to be Nike, but I do question Adidas.  And the easy thing hasn't helped them either. But I think, I'll tell you one, Under Armour. Like five years ago, Under Armour were basically Nike for the new generation, and they've had a whole bunch of things. It doesn't help that, you know, one of them was on Trump's love gang, so to speak. But it's like, when a brand needs to do a watermark of their logo in the corner of their TV ad, because they go, that's attribution. I'm not going, well, you're miles off, because attribution is, you know, about doing interesting things, not just boring people into submission. So yeah, there's a few things like that where I go, I could help you, but I could never help on drama. It's against my religion. Okay, so you have to phone up one of your friends and get some help. Yeah, that's the best way. And is the Jerry Maguire talk about that kind of stuff that we've just been talking about, or is it slightly different? It'll be slightly different, because I'm doing it with Martin and Paula, to phenomenal humans who are just two of the best planners in the world. So we'll evolve that. But the backbone is strategies about imagination, and it's getting weighed down by being about logic. There is a logic in what we do, but it's the logic is, with all this information and possibility, yeah, we're shuffling in inches rather than taking leaks. And yeah, we want to put the imagination back in, because ultimately that's in the, that's possible for all strategists, rather than just the elite that happen to work in really good agencies with money to spend on stuff. That's the basic premise. A quiet revolution, that's what I would love to start. Well, you've got bases in many places now and fans in many places now. So I'm sure that quiet revolution is going to grow marvelously well. So yeah, bravo. And then there was, gosh, there was something else I had on the tip of my tongue, but I totally lost it by looking down at a page of notes. Just, I mean, just while I remember, when you worked at Wyden then, did you get to meet Dan and work with him as well?  Yeah, yeah, another one on the long list. It was a very, well, it is a special place. But yeah, he was an amazing human. Yeah, what he, what he and Dan and Dave learn a whole bunch of others, but what they built and the environment for going after what's right, rather than necessarily what's the easy. Yeah, it's dead easy to sound glib, but it was a real honor to work for Dan. And you wanted to be great for him. And that's maybe the ultimate accolade any boss could achieve. You never asked for that. That was also part of it. But you wanted to do it for him, for the privilege and honor of being able to be there and being recognized that you could add something. So yeah, he was amazing. Yeah, I mean, I agree, he's an amazing guy, really lucky to have supper with him a couple of times when he was visiting Cape Town and with his wife. I think he was there for a conference and he announced, it was when he announced the shareholding of Wyden and Kennedy and that it would always be private. What were the kind of key takeaways that you took from working for that? I know you mentioned the culture and how marvelous that was. The culture, the belief in subcultures and cultural tension to get to great work, craft, always being forward thinking, but always looking to where things originated to get to the real truth of stuff. That creativity was not discriminated against by age. You were judged on what you did, not what you did, not what you had done. Like it was a very present energy. Yeah, and just the work comes first and lots of people can talk about that. But what I also respected was there was a demand that you really looked into stuff and you worked hard. You couldn't find it in. People who found it in got found out pretty quickly. Yeah, they were amazing to me above and beyond.  But yeah, they were special. The industry needed them, and maybe it still does. But there's others that I think are really interesting now, and that's a golden age. But yeah, it's like creativity is under threat. I honestly believe that because people want certainty.  And what people forget is creativity can achieve things that logic can't. And so there's, yeah, Wyden's there, there's a few others. I love Niels and then Common.  I really love Miss Chief. I think Greg's, yeah, there's a bunch of places. Yeah, there's a bunch of, a lot of them are small. But there's some big ones, I mean, Martin's now at AMV. And I think AMV did some amazing work. But I think they did the best TV in the UK for a long time, and very recently as well. So yeah, for me, there's some companies that are really great, but there's some amazing individuals as well. And so I will fight to support them as loud as I can, because I got, I got that support. And I got inspired by people who I think yeah, made a real impact by what they did and their beliefs. I remembered what I was going to say. And I know that we're running out of time. So we can close with this. You said something, you said earlier, which is like, okay, he said, he said, I love creativity. I don't like advertising. So there you go. Like that. I thought, I'm imagining this is going to be a good place to end on. Yeah, love creativity. Like, yeah, take it. Yeah. The best advertising has culture in it. The best creativity is culture. But when it's advertising done in a vacuum, it can be, there's, I'll leave you with this, there's a, there's a quote, of course, I've forgotten her bloody name, a Lucille Ball. And I'm gonna, I might get this wrong, but she said a man that can get a woman's age may be clever, but he's not very smart. And I love it because I think there's a lot of creativity that, well, a lot of advertisers that be clever, but not very smart, because it's done in a vacuum. And when you understand the context of what's going on, the symbolism, the hidden meaning, the language, the nuance, the details, that's when creativity and culture come together. And for me, that's what I'll chase after, not the advertising. Perfect. A thousand percent agree. We made so many courses on creative topics and creative subjects. And one thing that always comes up is, you can't find the answer, or it's very unlikely you're going to find the answer from behind your laptop on your keyboard or your laptop or whatever. You've got to get out there. You've got to speak to people, do things. And you've said that so often during our chat just now. So look, I really appreciate your time. Keep on doing amazing work. Look forward to seeing you in Cannes. I hope to see you in person. Say hi. And thank you so much, Rob, for taking time. I know you're a busy man. Don't be silly. Thank you for inviting me. I mean, a huge lack of judgment on your part, but I'm eternally grateful for that. So thank you so much. You're in honor. It's a pleasure. Thank you so much, Rob. Cheers. Okay, mate. Take care.


Hey coach. What's up? Welcome back to our YouTube channel. I want to make sure over the next couple of weeks because we're doing a five-part series here that you are Subscribed and that you are commenting below these videos if you have any questions And here is my phone number right here if you just go to this number and shoot me a text message I will respond to you. I want to personally help you and this series is all about making $10,000 or more per month with your business And I want to start this series off with a very fundamental just outlook and view on what it takes to earn $10,000 a month. Okay, and behind me You see this little dot and What happens is When you start your business you start very small And this is where you start to learn you you take a long time to understand things And this is how it was for me. All right, no one starts. No one starts at a 10 K-month level. It's impossible to do that. Okay, you have to think small at the beginning and This is where you have to just get started and make the decision And you could look at the sport that you're coaching. It could be soccer basketball baseball tennis pickle ball Rocket ball. I don't give a crap what sport you coach doesn't matter to me It just takes the idea of saying hey, I Have this this expertise in this in the sport and I know I can coach at a high level and I know I can give personalized Coaching if you have that down Okay, well, I'm about to show you in the next couple of weeks It's going to work and I promise if you're willing to put in the work And if you want to work with me on it like I'd love to help you But it all comes down to starting small Okay, because when you start small All right, I think a great goal to have at the very beginning is well, you know, let's see how We can make an extra $500 a month. That would be a great target even if you are Already in business right now. I would think well in the next 30 days What can I do to make an extra $500 a month and have a small goal again when we start small at a Lower target. Okay. This means that over the next 30 days You're doing something that's adding $500 per month over the next hopefully 12 months if you have that set up the way that I teach you, okay, and From there we're taking little baby steps. So this little circle we have when you're starting Gets a little bit bigger and then as we start increasing this all right the next goal would be well We're already making $500 more per month. How can we double that? How can we make a thousand? More dollars per month. So that's 1500. So this is compounding. So now we're at an extra 1500 per month Okay, again This is getting bigger. So your business is growing You have to start small though if we try to start off with this grand idea of oh I need to make $10,000 a month and you don't take the first action You know the first steps it's not going to happen. So you have to start small. Okay, then from here And over the next four videos, I'm going to systematically show you how to do this All right, but we want to set down the foundation All right, but then from here. It's like well, how can I make an extra $2,000 per month on top of this? Okay, so we take 1500 plus 2,000 that is 4500 So right 3500 and you have to think about this right now If you have systems in place and you just start off small You could get to $3,500 per month Within I would say I don't know a 90-day period if you just work really hard And I know this is the level most coaches know if they can get there They could quit their job and I've seen a lot of coaches in our mastermind quit their job within a 3060 or 90-day period if they decide to sack up and do the work, right? So this very doable and the reason why we're starting small though is because if you have this grand vision of making 10k a month But you don't know how to do it and you go a couple months without making $10,000 a month Then you're gonna feel down. You're gonna feel discouraged and you're gonna give up It's why we got to take little baby steps and then from here All right, we can grow that you can say well, how can I make an extra $4,000 a month? on top of this Okay, then from here where it 7,500 And here's the cool thing in order to reach 10,000 you need 2,500 more dollars here and you already know how to do that Because we've already done these two and that has proven that this works Okay, and again, this all comes down to just your mindset of how you look at your business from the very beginning Or how you look at it right now Like you could be at four or five thousand dollars a month right now and you want to get to the 10k level But maybe your systems are backwards. Maybe you don't have automated billing in place Maybe you don't have any marketing place. Maybe not enough parents know like and trust you in your area Like this all comes down to you Right just taking a deeper look at well How can I set this up and how can I do this in a way where it's leveraged and over the next couple of weeks the next four weeks To be exact we're going to break this down But this is something I really want you to look at and just understand before we get to those videos All right, so that's it for today's video remember if you want to text me shoot me a text right here I'm ready to help you out wanting to help you out take advantage of that Just shoot me a text. I'll see you later