1 00:00:00,030 --> 00:00:00,890 I want to have you. 2 00:00:00,890 --> 00:00:11,400 You must adhere strictly to the time and days of intake, medical advices and negotiations on medical authority in Nigeria and HIV consultation. 3 00:00:11,400 --> 00:00:23,370 So I will begin with an introduction to the church, followed by the research for cause the data copper's beta process and the method of data analysis. 4 00:00:23,370 --> 00:00:31,800 The findings of the research. And my concluding thoughts or statements. 5 00:00:31,800 --> 00:00:41,190 How did research on medical authority in medical sociology and medical composition analysis present two distinct arguments? 6 00:00:41,190 --> 00:00:49,500 On the one hand, researchers teach that doctors paternalistic approach to medical encounters is quite predominant, 7 00:00:49,500 --> 00:00:56,130 and this constitutes the underlying cause of patients non-participating behaviour during consultations. 8 00:00:56,130 --> 00:01:02,850 Although there are various perceptions of the doctors authority and this vary across various cultures, 9 00:01:02,850 --> 00:01:12,990 the notion of paternalistic dominance really implies that the doctor's authority limits patients centred work. 10 00:01:12,990 --> 00:01:14,640 And this is evident, for instance, 11 00:01:14,640 --> 00:01:27,060 when she said physicians adopt a greater position of epistemic and deonte authority that is relative to the patient when recommending treatment. 12 00:01:27,060 --> 00:01:34,860 Then, on the other hand, findings indicate that doctors work to withdraw some of this authority, thereby encouraging the patients to, for instance, 13 00:01:34,860 --> 00:01:43,770 participate more in the encounters by maybe answering more than the question that doctors are asking during medical history taking, 14 00:01:43,770 --> 00:01:53,340 or sometimes also requests for diagnostic diagnostic tests in the process of consulting the patients and asking for the patient's concerns. 15 00:01:53,340 --> 00:01:58,630 And the patients will be. Now, 16 00:01:58,630 --> 00:02:05,110 to learn more understanding on these two perspectives as a research of thought that an 17 00:02:05,110 --> 00:02:12,430 examination of the advice given sequences in medical interactions become insightful, 18 00:02:12,430 --> 00:02:18,730 and especially because the pragmatic understanding of and advice means telling you what is best for 19 00:02:18,730 --> 00:02:26,650 you to do and in professional talent and countless advice giving is not massively uni directional, 20 00:02:26,650 --> 00:02:35,090 so it often happens in situations where the doctors will be the one to offer the advice to the patient. 21 00:02:35,090 --> 00:02:44,530 So and this justifies, to some extent my reason for taking the professional as a point of departure for the 22 00:02:44,530 --> 00:02:50,140 exploration of this particular intellectual practise in medical and health related settings. 23 00:02:50,140 --> 00:02:56,110 Advisory interactions that have been the focus of extensive research by linguists, 24 00:02:56,110 --> 00:03:00,670 including interactions between health visitors and first time mothers in Britain, 25 00:03:00,670 --> 00:03:05,290 and so many other interactions, also including mediated interactions. 26 00:03:05,290 --> 00:03:12,190 The central arguments indicate that certain factors influence participants actions and advisory interactions, 27 00:03:12,190 --> 00:03:15,430 and these include the social context of the interactions, 28 00:03:15,430 --> 00:03:22,750 whether one would be the Scots taboo topics and of course, the impacts of the societal and cultural ideologies, 29 00:03:22,750 --> 00:03:29,810 including the epistemic anxiety asymmetries between the doctor and the patient. 30 00:03:29,810 --> 00:03:39,770 So in view of these findings, this paper contributes to some extent to previous research by investigating how 31 00:03:39,770 --> 00:03:45,800 medical authorities negotiated through the communicative practises of advise giving. 32 00:03:45,800 --> 00:03:50,960 And of course, also looking at its responsive actions in India on HIV consultations. 33 00:03:50,960 --> 00:03:59,700 So basically, I want to look at our advice. Given this, I reflect a consolidated and negotiated India account. 34 00:03:59,700 --> 00:04:08,460 Now, just a quick look at an extract that shows that advice giving is indeed negotiated in the major HIV. 35 00:04:08,460 --> 00:04:11,900 One. Then I use this word negotiating a very negotiated share, 36 00:04:11,900 --> 00:04:19,730 not negotiate or negotiate that very often to refer to all the practise of advice given comes through in interaction. 37 00:04:19,730 --> 00:04:25,910 In that sense, now in this extract, the patient does not seem to be thriving medical. 38 00:04:25,910 --> 00:04:31,970 She stores instructed to take various medical texts and use prophylactic drugs. 39 00:04:31,970 --> 00:04:36,440 The patient had complained about stomach ache, and a CD4 count is low. 40 00:04:36,440 --> 00:04:40,520 These are not shown in the extract the up to Iowa states, 41 00:04:40,520 --> 00:04:50,930 but a stomach ache is probably caused by using painkillers a la booking, an e-book of the locally made painkillers in Nigeria. 42 00:04:50,930 --> 00:04:57,170 And you know, we can look at how that really takes place in the first Langton in. 43 00:04:57,170 --> 00:05:02,330 Now, in the 10th line, the patient is instructed to stop taking the painkillers, Doctor says. 44 00:05:02,330 --> 00:05:12,020 So you stop using its Anthony nine 12 and that one is initiated that gives more instructions concerning conducting chest X-rays. 45 00:05:12,020 --> 00:05:17,960 Now, these instructions are substantiated and reinforced with the Dr. self-initiated self-repair 46 00:05:17,960 --> 00:05:21,890 that addresses the problem of hearing when the patient does not immediately respond. 47 00:05:21,890 --> 00:05:27,680 When he sees you year in and year out, when someone tells you, you hear me. 48 00:05:27,680 --> 00:05:32,360 If not most of the time, it happens within a month. This is not certain. 49 00:05:32,360 --> 00:05:40,070 It's not a request for clarification or a request to actually, you know, 50 00:05:40,070 --> 00:05:46,280 understand whether or not the other participant has heard what you said it is to reinforce this or some sort of instructions. 51 00:05:46,280 --> 00:05:52,640 I sort of order. That's the well, the first person who has altered his statement has, as mentioned, 52 00:05:52,640 --> 00:06:02,120 not Israel should essentially that the doctor's instructions are used to assess his role as a doctor and established his role and of course, 53 00:06:02,120 --> 00:06:07,010 also set future course of the patients are there is medical recommendations. 54 00:06:07,010 --> 00:06:12,140 We'll take a more in-depth look at this phenomenon subsequently. 55 00:06:12,140 --> 00:06:20,720 Now, this study draws from 70 doctor patient interactions, which were collected in 10 visits for outpatient clinics in Nigeria. 56 00:06:20,720 --> 00:06:25,370 Start with its cousin between August and December 2015. 57 00:06:25,370 --> 00:06:31,670 This was during the time I was conducting my practise and of course, during the postdoctoral stage as well. 58 00:06:31,670 --> 00:06:36,860 I went out to do some, some more fieldwork to, you know, get some more data. 59 00:06:36,860 --> 00:06:42,050 Now these visits were made to the clinic to record interactions between doctors and patients. 60 00:06:42,050 --> 00:06:47,450 The audio files were a total of eight thousand seven or fifteen minutes twenty nine hours in total. 61 00:06:47,450 --> 00:06:56,060 The map shows the study area. The clinics are federal and state hospitals, which provide outpatient services to HIV positive patients. 62 00:06:56,060 --> 00:06:59,060 Now, other select clinics, doctors and patients converse in Eurobank, 63 00:06:59,060 --> 00:07:07,820 which is the native language of the ethnic group in southwest Nigeria, sometimes also the participants using Nigerian, 64 00:07:07,820 --> 00:07:18,050 pidgin, English and Nigerian English, and all linguistic codes, including cases of code mixing and other languages used in the interaction. 65 00:07:18,050 --> 00:07:23,990 The participants consist of eight male doctors, two female doctors and 70 patients. 66 00:07:23,990 --> 00:07:30,980 Now, the recordings involve a minimum of two practises by interactions and, of course, data collected for this. 67 00:07:30,980 --> 00:07:34,670 So do you have to make sure was approved by the local ethics and research committees of 68 00:07:34,670 --> 00:07:39,200 the selection mix and patients who participated during the study in a well-informed. 69 00:07:39,200 --> 00:07:50,320 Give informed consent about this study, and they also give you a permission to publish their their recordings. 70 00:07:50,320 --> 00:08:00,160 Now, audio recordings of interactions with transcribed using the transcription convention provided by German linguists, 71 00:08:00,160 --> 00:08:07,810 and it was likely because I studied in German Germany anyway, so my supervisors feel that this would be something that would be nice to use. 72 00:08:07,810 --> 00:08:16,990 They are all that transition conventions used by Jefferson and some other prominent C scholars, but I use the gut to transition convention. 73 00:08:16,990 --> 00:08:23,980 And like I said earlier, this sort of adopts competition analysis for data processing analysis. 74 00:08:23,980 --> 00:08:28,690 Now, Medical sees a body of research reading a strong analysis that focuses on analysing 75 00:08:28,690 --> 00:08:34,900 fine grained detail or instructional practises and actions within medical settings. 76 00:08:34,900 --> 00:08:42,250 Case preferred for this study due to its objective and empirical focus on analysing naturally occurring interactions. 77 00:08:42,250 --> 00:08:52,780 Now, moving on to my findings before I bore you too much. No, as you'd seen in the analysis, 78 00:08:52,780 --> 00:09:02,620 we are going to be looking at how doctors issue medical advice that specifically enforce patient adherence to medical recommendations. 79 00:09:02,620 --> 00:09:10,600 Now, so finding that adherence really informs the primary reason for offering advice. 80 00:09:10,600 --> 00:09:16,540 The second step the analysis will explore the town designs of the advice giving sequence. 81 00:09:16,540 --> 00:09:25,330 Now I'm going to be using instructions interchangeably with some advice, and this is in response to the patient's deteriorating medical health. 82 00:09:25,330 --> 00:09:34,330 And such evaluation is organised such a way that patients agency insure decision making on the treatment routine is not recognised, 83 00:09:34,330 --> 00:09:37,540 as we saw in previous following extracts. 84 00:09:37,540 --> 00:09:46,780 Also, the doctor's directives are made relevance with tongues that do not allocates proceeding tons for patients to respond. 85 00:09:46,780 --> 00:09:54,430 Advisors are also issued as optics on patients just preferred responses, and they are also mitigated by accounts. 86 00:09:54,430 --> 00:10:06,460 These patterns are privileged in about 80 percent of interactions. That's only about seven through sequences, treatment or conditional sequences. 87 00:10:06,460 --> 00:10:16,720 Now I move on to the first observation. The reasons for offering advice on the treatment we're seeing now. 88 00:10:16,720 --> 00:10:24,310 This is so prominent in the data because probably given the fact that the context of the interaction and 89 00:10:24,310 --> 00:10:33,550 the type of patients that are being spoken with adherence is very central to HIV care because I mean, 90 00:10:33,550 --> 00:10:39,100 the the patient LS depend on their regular and consistent intake of your drug anyway. 91 00:10:39,100 --> 00:10:45,970 So I suppose this justifies the reason why there's so much focus on the adherence to medical recommendations. 92 00:10:45,970 --> 00:10:55,210 But I think the interesting thing for me from the outset was that the concept of identity really goes beyond just drug use, 93 00:10:55,210 --> 00:11:02,410 as I've found a community teacher. So there's always so much emphasis on patients using drug patients using drugs. 94 00:11:02,410 --> 00:11:15,280 But in the clinic settings, adherence tends to, you know, I have a more holistic perspective such that the patients use of the patient's use of drug, 95 00:11:15,280 --> 00:11:22,600 the patient's regular CD4 count testing and the patient's regular visits to the clinic to collect a fully 96 00:11:22,600 --> 00:11:30,370 distributed Altis are so important that all of this constitutes factors in which the doctors consider. 97 00:11:30,370 --> 00:11:33,130 And that's why I joke that the patients are not DairyNZ or not. 98 00:11:33,130 --> 00:11:43,810 So I wanted to put this in mind when I speak about doing so doesn't only refer to drug use alone, no advice on patient, I mean, advice on patients. 99 00:11:43,810 --> 00:11:50,560 Good medical course when patients are healed from opportunistic infections, as shown in this extra year, 100 00:11:50,560 --> 00:11:54,850 the doctors medical authorities asserted when E. struck the patient to, first of all, 101 00:11:54,850 --> 00:12:01,270 purchase drugs outside the clinic before receiving drugs from the clinic. 102 00:12:01,270 --> 00:12:07,840 The patient response by expressing reservations about the effectiveness of the current treatments. 103 00:12:07,840 --> 00:12:16,090 So she requests an assurance of future wellness if she attends the doctor's instructions. 104 00:12:16,090 --> 00:12:22,240 The doctors response to this reservation serves to assure the patient for good medical health by leaning towards a religious reference. 105 00:12:22,240 --> 00:12:27,430 When you say by God's grace, you'll be OK. By God's grace, you'll be well. 106 00:12:27,430 --> 00:12:36,220 And also, this was a medicated little concern. Like, we have it in line now, you say said, make sure you take it and use your drug every day. 107 00:12:36,220 --> 00:12:48,190 Although the instructions here advocates for the patients good medical, it's it's obvious that Dr. Leverage is also on his epistemic superiority. 108 00:12:48,190 --> 00:12:54,750 That's an. In terms of his knowledge of know-how is knowledge of the nature of his profession and the opportunities 109 00:12:54,750 --> 00:13:04,070 that the profession offers him to direct the patient's future action with regards to our health. 110 00:13:04,070 --> 00:13:10,310 Now, concerns relating to patients health related behaviour also serves to enact medical authority, 111 00:13:10,310 --> 00:13:15,410 assuming these extracts are what about the drug that the doctor prescribed for you? 112 00:13:15,410 --> 00:13:23,300 Make sure you study drugs, did you buy one that looks at it is what are inside and then when the patient is? 113 00:13:23,300 --> 00:13:28,340 Yeah, that's usually what I say is an assessment of the response. 114 00:13:28,340 --> 00:13:34,130 And I just say I didn't buy this hour right before you go and buy it right for me, I go and buy, do you said Chin. 115 00:13:34,130 --> 00:13:38,070 Also, I use as an OK, use U.S. Army, so I use it always. 116 00:13:38,070 --> 00:13:44,750 So also is very like to discuss. Market is very similar to the EU. 117 00:13:44,750 --> 00:13:50,550 Yeah, you know that we had looked at earlier. That really reinforces obedience. 118 00:13:50,550 --> 00:13:59,090 You now, as we can see a case about the price previously prescribed RC and subsequently instruct are to use it. 119 00:13:59,090 --> 00:14:06,020 Not that doctor request to know about another type of drug that she may have bought in line fifty two or three. 120 00:14:06,020 --> 00:14:12,470 So when the patient offered it this preferred tone in Line 54, an instruction follows again, I'll write it for you. 121 00:14:12,470 --> 00:14:17,690 Go and buy it in like two to five and 56. Now the patient's response is cooperating, 122 00:14:17,690 --> 00:14:23,660 she has said this prescription and consent to follow these doctors instruction when she says yes, write it for me. 123 00:14:23,660 --> 00:14:27,800 However, when he repeats instruction, go on, buy it and use it. We see here. 124 00:14:27,800 --> 00:14:39,410 But I mean, the term design I mean of the doctor's instructions allows does not really call for a negotiated agreement. 125 00:14:39,410 --> 00:14:44,930 And then the patient also shows that these instructions do not require a jointly formulated decision. 126 00:14:44,930 --> 00:14:51,170 Making on treatment would seem rather. She submitted rights and against doctor's instructions on the prescribed Treat me. 127 00:14:51,170 --> 00:14:56,030 I'm going to see a lot more of these. I'm not going to really go in-depth on the obvious. 128 00:14:56,030 --> 00:14:59,990 Yet these are the one is the advice on my routine. So like I mentioned earlier, 129 00:14:59,990 --> 00:15:05,000 the reason for offering the advice and the return design of the advice sequences are really 130 00:15:05,000 --> 00:15:12,020 locations or spots in the interactions through which we see how the doctor negotiates authority. 131 00:15:12,020 --> 00:15:16,700 So I ran briefly through also the trial design sequences. 132 00:15:16,700 --> 00:15:21,710 Now, when I say that there are no time allocation for patients responses, 133 00:15:21,710 --> 00:15:28,580 I mean that at very appropriate point in the interactions when patients should offer more, they offer less. 134 00:15:28,580 --> 00:15:34,670 And that is because there are no explicit questions that require some sort of response. 135 00:15:34,670 --> 00:15:45,530 And of course, through which they can, each of the parties can jointly negotiate decision or share decision on treatment. 136 00:15:45,530 --> 00:15:47,210 So as we see here, 137 00:15:47,210 --> 00:15:56,090 the second over hacking observation is that doctors established medical authority through trial designs of the advice given to patients. 138 00:15:56,090 --> 00:15:59,510 Now I saw the patient's apparent good medical ethics everything. 139 00:15:59,510 --> 00:16:08,360 She's evidently in good health, although she has no complaints and has no M.D. for count and all of that. 140 00:16:08,360 --> 00:16:21,260 However, this does not, you know, um, you know, stop the doctor from giving such very explicit instruction on Skippy that we added to your drugs. 141 00:16:21,260 --> 00:16:26,150 And of course, the patient is just left to agree. OK, thank you, doctor. Yeah, you've done the right thing. 142 00:16:26,150 --> 00:16:31,880 You had medical professional implications. 143 00:16:31,880 --> 00:16:40,070 Now the issuing of instructions in the imperative format also, of course, when your doctor offered an optic on a patient, these preferred responses. 144 00:16:40,070 --> 00:16:45,020 These are technical terms. I'd be dicey because they are. 145 00:16:45,020 --> 00:16:50,360 We'll see a related terms by term design time designs. 146 00:16:50,360 --> 00:16:57,560 I understood in terms of, I guess, take pays in C such that all chances comes in pair when a greeting is offered. 147 00:16:57,560 --> 00:17:04,670 A greeting is innovative response to a greeting when you make a request. 148 00:17:04,670 --> 00:17:09,990 The expected return is that, you know, the person gives you a positive response and so forth. 149 00:17:09,990 --> 00:17:14,480 And so of course, when you also ask a question, the hospital response is an answer. 150 00:17:14,480 --> 00:17:21,890 But sometimes these preferred responses appear in such a way that, well, 151 00:17:21,890 --> 00:17:29,180 I wouldn't say the preference system does not really talk about the the the preference of the speaker in that term. 152 00:17:29,180 --> 00:17:36,620 It talks about the grammatical grammatical mess in terms of grammatical construction of the 153 00:17:36,620 --> 00:17:42,620 utterances in what one utterance would require in terms of the response to the utterance. 154 00:17:42,620 --> 00:17:48,120 So it's preference instead of looks at it from the perspective of the grammatical makeup of the utterance. 155 00:17:48,120 --> 00:17:53,040 So when someone offers a district judge response, as you would know in interaction, 156 00:17:53,040 --> 00:18:03,380 sometimes when someone asks you something or make a request when you are about to not agree or we know about your partner not to conform to. 157 00:18:03,380 --> 00:18:13,910 The action that request Axel, if you do something so there are months, sometimes you delay your response or I'd like to take you to lunch today. 158 00:18:13,910 --> 00:18:18,950 I may be busy. You are about to offer this report response. And so they are marked by delays. 159 00:18:18,950 --> 00:18:22,910 They are marked by sometimes by account. If you want to say no, you can give an account. 160 00:18:22,910 --> 00:18:30,420 If someone says, Well, I want you invited to lunch today because they're, well, actually, I'm actually going to maybe this two sentences. 161 00:18:30,420 --> 00:18:34,370 I'm going to give an account for why you would not obey the request. 162 00:18:34,370 --> 00:18:44,060 So that's how the preference systems look. And of course, when someone at the time optic, if more or less response on how the response is designed, 163 00:18:44,060 --> 00:18:52,670 you know how the the tone from and all the other parties or tracks also, you know, really major sweeps. 164 00:18:52,670 --> 00:19:28,730 OK. So, like I said, any additional instructions as an interesting format, of course. 165 00:19:28,730 --> 00:19:35,830 Also here we see also like we've been saying before, instructions you have to go and do it now. 166 00:19:35,830 --> 00:19:40,990 See what happens? You have to wonder this tests and the patient offered a justified response. 167 00:19:40,990 --> 00:19:45,760 Yes, this is my test. I wouldn't be able to do it. I don't have money. 168 00:19:45,760 --> 00:19:51,430 I mean, line it says it's not the type you pay for. This one is free, so you have to do it. 169 00:19:51,430 --> 00:19:56,800 And she agrees again. OK, so what we see here is that, first of all, 170 00:19:56,800 --> 00:20:07,900 the use of the honorific Tamar is really in reference to the Iraqi position between doctor and patients. 171 00:20:07,900 --> 00:20:15,640 I mean, I have not been to medical encounter where the patient calls the doctor by name to even start with is always Mr. Doctor Sir. 172 00:20:15,640 --> 00:20:19,540 And so already there's already an Iraqi police. 173 00:20:19,540 --> 00:20:28,480 So, you know, even in the event that maybe non-compliance, or maybe I would see disobedience if I could use that term to do. 174 00:20:28,480 --> 00:20:36,640 Moving on. Still, the final one also advises students that are being targeted by accounts. 175 00:20:36,640 --> 00:20:44,110 Instructors may be given us pronouncements in a sequential environment that offers an extended explanation for the instructions. 176 00:20:44,110 --> 00:20:52,240 In other words, instructions may be mitigated by doctors accounts as evidenced in this shot extracts doctors a doctor. 177 00:20:52,240 --> 00:20:56,380 This doctor formulates its treatment of us with a pronouncement in lines one and two. 178 00:20:56,380 --> 00:21:04,550 You have to do this. You have to take this drug. Then you proceeds by offering an explanation that audiences pronounce names as systemically 179 00:21:04,550 --> 00:21:08,900 immobilised initiative about the inappropriateness of the patient's previous drug. 180 00:21:08,900 --> 00:21:12,700 This is all it seems. I see what I gave you earlier. It's not working. 181 00:21:12,700 --> 00:21:19,150 So by saying your aims towards the knowledge that the previous drug was inappropriate and then not to be given to the patient, 182 00:21:19,150 --> 00:21:29,210 not to be changed on this premise, I did not specify the new drug these two drugs and then instructs how to get those drugs are the pharmacists. 183 00:21:29,210 --> 00:21:35,650 In effect, the patients request for clarification on the current Iraqi case doctors authority may be 184 00:21:35,650 --> 00:21:44,640 perceived as being weakened slightly because it is shown on drug change may be indecisive. 185 00:21:44,640 --> 00:21:52,800 Now, move on to a discussion quickly, as I've tried to show briefly related trajectories, 186 00:21:52,800 --> 00:22:02,190 I really made relevant during twinges treatment discussions and this and this sequence is characterised by the practise of giving instructions. 187 00:22:02,190 --> 00:22:11,460 The focus on patients adherence is really crucial because it exemplifies the phenomenon of shared or non strong making between doctor and patient. 188 00:22:11,460 --> 00:22:15,060 It also really touches on the issue of patient expertise. 189 00:22:15,060 --> 00:22:24,060 It touches also on the issue of Dr InStyle's and, of course, advancing the discussion on the problem of compliance amongst patients. 190 00:22:24,060 --> 00:22:34,500 The ratification of medical authority, of course, regardless of the possibility that patients may participates in the interactions or not. 191 00:22:34,500 --> 00:22:46,050 What I have observed that the patients are mostly neglected doing shared decision making, so they offered advice and give me simultaneously and offer. 192 00:22:46,050 --> 00:22:52,260 Of course, it reflects on the error. It reflects on patients maintenance of their responsibility for wellness. 193 00:22:52,260 --> 00:22:54,510 So there is this true faith dynamic. 194 00:22:54,510 --> 00:23:02,670 I see that it's very obvious that doctors have some sort of a Germany, have some sort of autonomy over patients willingness, 195 00:23:02,670 --> 00:23:13,440 but also there's a tricky side to it because simultaneously they construct responsibility with the patients on alt related behaviour, you see. 196 00:23:13,440 --> 00:23:20,430 So these are two different perspectives that I think, you know, needs to be more explicit. 197 00:23:20,430 --> 00:23:27,270 Meanwhile, in the literature, the the focus on austerity is always on two different extremes. 198 00:23:27,270 --> 00:23:32,700 So that, you know, is both those videos pretty authoritative or not authoritative. 199 00:23:32,700 --> 00:23:34,920 But how about when data is authoritative, 200 00:23:34,920 --> 00:23:43,440 but also making allowance for the patients to exercise our own autonomy as well or agency and in indoor consultations? 201 00:23:43,440 --> 00:23:47,130 So I think I'm ready at the end. 202 00:23:47,130 --> 00:23:52,800 I'm sure half of my time. OK. 203 00:23:52,800 --> 00:23:59,850 So I would like to want to suggest that for I mean, for future discussions. 204 00:23:59,850 --> 00:24:05,580 And, you know, when cross-fertilisation of ideas on how to go about these issues, 205 00:24:05,580 --> 00:24:10,260 especially with respect to interactions in African states and in Nigeria, 206 00:24:10,260 --> 00:24:19,290 I think it's a need to accommodate a broader concept of what our various means in the first place and also what it means to have medical authority. 207 00:24:19,290 --> 00:24:26,280 Could it also be that medical authority is established or in place for the patients benefits, 208 00:24:26,280 --> 00:24:36,660 especially when it comes to chronic puts in context such as this? So I think this opens up to more discussions in that area. 209 00:24:36,660 --> 00:24:46,467 I think I'm at the end now so that if you show that conducted, then thank you for listening to questions.