September 8, 2021
Sanjula Jain 0:03
Women make up 70% of the healthcare workforce but only 20% of its leadership. On Her Story, we’ll explore the careers of bold and influential women from Silicon Valley to Capitol Hill and learn how they’ve overcome the odds. I’m your host, Sanjula Jain and this is Her Story, a program where we explore what’s beyond the glass ceiling.
Sanjula Jain 0:26
I’m delighted to welcome Dr. Stephanie Hartselle, CEO of Hartselle and Associates and Clinical Associate Professor at Brown University. Stephanie, thanks for spending some time with us this morning.
Stephanie Hartselle 0:35
Thank you for having me on.
Sanjula Jain 0:37
You have a phenomenal career as a physician leader in the industry, and we’ll dig into your whole profile in just a minute. The point of this special series in partnership with WIMS is to highlight some “non-traditional” career paths for those who study clinical practice, so let’s start from the beginning. What inspired your interest in medicine?
Stephanie Hartselle 0:58
I think as young as four or five, I really wanted to be a doctor. We didn’t have doctors in our family. In fact, I grew up on a rural farm in Northern California and my mom was an elementary school teacher. Otherwise, we didn’t have anyone in the family who was any kind of white-collar professional. Oddly,—and it relates to later on what I do—the first thing that made me super inspired to become a doctor was the show M*A*S*H. I watched every episode when I was young and I still remember cases from the show that were dramatized. 40 years later, I’m still recalling, “Oh, I saw that episode on M*A*S*H,” which probably is an internally odd dialogue to have. That’s part of what had started it.
Sanjula Jain 1:46
I did not know that, but that makes so much sense. We’ll get to the next part of your career path, but why psychiatry specifically?
Stephanie Hartselle 1:55
As I went into medical school, I took a different route. I had not done super well in high school or college. It wasn’t a priority to me, I wanted to be a doctor. But as I went forward, I realized I was better in language arts and Fine Arts. My family, who also wasn’t in the sciences at all, had said, We don’t tend to do math or science, and we aren’t good at it. And so I threw out that idea of becoming a doctor. And I just didn’t even know the path to have that happen. In the middle of college, I was in Oregon and one of the local fire departments needed volunteer firefighters and volunteer EMTs so I went through the courses to become both and found it fascinating. Another job had opened in Portland at the level one trauma center. And so I became an ER tech, which is essentially I mean, I emptied bedpans. It was really kind of a glorified janitor, but I really, really loved it. And so I loved emergency medicine. And I thought that’s what I’d wanted to do. As I went in and declared myself I’m going to be emergency medicine. And then as I went forward, I realized the things that I loved about emergency were the trauma, the traumas that we dealt with, and then also psychiatry, and making a decision about surgery, which tends to be if you take the trauma path versus psychiatry, I just I felt such an affinity for psychiatry. I actually didn’t realize it in a true eventual psychiatric professional fashion. It was the other people around me who realized all you talk about our people’s stories, and also, you ever get very, very excited about psychiatric illnesses. And so I was really I think I was worried about going to psychiatry, I thought, why would anyone do this? So you sit behind a desk and you write prescriptions, but mostly you talk to people like why wouldn’t I have done a Ph.D. for this? As I went forward, I realized you can do anything you’d like with it. And so we actually do quite a bit of medicine in my practice, which was great. I love my job. I feel incredibly lucky and blessed to have done this. I went into it because it was the thing that I liked the most out of all the rotations. But I loved all the rotations, honestly, with the exception of very few. To this day, it’s created a lot of flexibility in my life.
Sanjula Jain 4:04
As you know better than anyone, over the last year and a half now behavioral health and mental health has been particularly in the spotlight. And as you and I chatted earlier, you’ve been looking at this for many years now well before in some ways there was more national attention to this issue. And so how do you think about the evolution of the healthcare industry when it comes to really investing in mental health, behavioral health and what do you think is going to ultimately move the needle going forward?
Stephanie Hartselle 4:33
I am upset that it took a global apocalypse to have things put into more of a spotlight than it was in the last few years. But I am also glad it does feel like the necessity and how critical it is to our general health and well-being was long overdue and I am so happy and grateful that the specialty of psychiatry within medicine was always one that was relegated to people. We were either very, very passionate about it, or for some reason, it was always a mess. But it was for people who couldn’t get into anything else. Oddly, in the last five or so years, that has really turned on its head. It’s one of now the more competitive specialties to try to match in, which is both great and wonderful and inspiring. We need so many of them. The expansion of training and everything within psychology, masters-level clinicians, and psychiatrists, really needs to be a priority. We saw a lot of devastation during these years of isolation and these years of unknown. What’s going to happen in the future? For most of us, it redoubled our efforts toward how we get the message out there. How do we make sure that this trend continues and expands?
Sanjula Jain 5:49
From where you started from those early days of watching M*A*S*H and seeing patients to doing a lot of that today. A lot of that was probably unplanned, to some extent, or something that you didn’t envision was possible. One of the questions we like to ask all of our guests is how they think about their foray into healthcare leadership. Do you think that path was more intentional or accidental? What’s the story behind that?
Stephanie Hartselle 6:18
Like so many people who enter medical school, I had an enormous imposter syndrome that I didn’t understand the term for. I thought it was because I had come from a family who wasn’t in medicine. I also felt like I had taken a lot of different routes to eventually get to the same place as my classmates who were so impressive, so impressive and intimidating. And I kept and I talked about this during my lectures to the Brown students as well. I kept expecting in the large class lectures that someone was going to walk in and say, “Oh, Stephanie Hartselle. We actually meant to admit Stephanie Hurtwell, so you have to go. We made a mistake.” Even into year two, I was expecting someone to walk in and say, “You’re not supposed to be here.” In talking about that, it feels like it is a common experience. As far as the accidental versus intentional leader, I think there are two aspects to this. One was and I’m more selective about this now, but I’ve heard it on your program from other leaders, too. I tried to say yes to every opportunity I could. And now I’m much more selective because as you say, Yes, your opportunities really expand and expand, and they could go on forever, you could fill every hour of the day. And but initially, it was just trying to say yes to opportunities and meet people and learn about what I was doing. As far as opening my own practice went, I just noticed that the frustration that I had within the systems, which are of course, limited by all kinds of things, the finances of a large, and always the slow moving medical centers, they have to be slow moving, right, they’re carrying hundreds, if not 1000s, of employees and patients with them. But also, the private and insurance companies who are increasing their dictation of how care is meant to be and the administrative trash that comes with all of that. As I moved into the idea of running my own private practice, it just became clear to me that I wanted to be able to call my own shots, I wanted to be able to see the people that I wanted to see, I wanted to be able to do therapy if I wanted to, or design a practice that I was excited to, to be in. And then once I started adding more doctors, I was excited to have these amazing physicians with me providing their own idea of ideal care.
Sanjula Jain 8:28
Unpack that a little bit because you make it sound so easy but some days, especially today, being in private practice—just from like the healthcare ecosystem, when it comes to the reimbursement and the incentives and all the technology—is so challenging. We’re seeing press releases every day about a lot of groups getting acquired and all of that, but take us back to the tipping point when you were seeing all these things and you said, “I’m gonna go out and do this on my own?”
Stephanie Hartselle 8:54
I went through general psychiatry and pediatric psychiatry fellowship. After that point, I—not surprisingly—got the job as the medical director of emergency psychiatry at the children’s hospital. It was known to be an incredibly high burnout, high stress job. The duration that people had lasted within that job was often far less than two years because it had such high turnover. We were dealing with such ill children. I think the lack of ability to make sure that consistent, outstanding care was provided from start to finish was just incredibly challenging. And I remember sitting, you know, in a meeting and talking about what has been the previous vision for this program, and what are we thinking about going forward, and I have some ideas. These are their slow-moving institutions. But I think my frustration with not being able to express the idea that we would have a vision for how this program would be shaped going forward, was one of the tipping points, and then secondarily, knowing we could make some changes that would improve the outcomes of these kids. But finally, the obstacles were higher and higher to get there and made it so I thought I needed to give substantial notice—because we all do in medicine—and think about going into my own private practice. It wasn’t easy. I decided to do it, open my door, hung a shingle, and we were all set. I had to go slowly, I had to make sure I had my husband as a stay-at-home dad. I had to make sure we had some bridging work that was consistent because I didn’t know for sure if this would work. One of the things probably a bit pathological about me is that, when people tell me I can’t do something, I say, “Oh, yeah? Watch me. I will.” For better or for worse, if you think that I can’t do this, I’ll show you. I’ll prove you wrong. Luckily, that’s led me down some really great paths, but Rhode Island is an odd place where there aren’t as many people in private practice. There are some insurance rules around that make it even more difficult. I remember the Chief Medical Officer of our academic medical center saying, “Yeah, I don’t think you’re gonna be able to do this.” He wasn’t trying to be a jerk, I don’t think, he was just trying to lay out what he thought were the realities about opening a cash practice and being able to see patients you wanted to do and see. The main idea I had was to use a cash-based practice to also open up and see other folks who maybe weren’t able to see a psychiatrist for therapy and do so free of charge. How would I structure that and do that?
Sanjula Jain 11:32
I’m sure one of the things you and I both agree on is that leadership is a lifelong learning process. To that point, thinking that you were trained more clinically, you go off to create your own private practice with that comes running a business and technology and operations, right? It’s I mean, and that only is that just wow, a lot of skills and a bunch of new domain expertise. But how did you navigate that in terms of the learning process, or new skills that you’ve developed along the way? How did you know where to start?
Stephanie Hartselle 12:05
I purchased every book in private therapy practice I could find. There weren’t very many at the time, this is now almost a decade ago. There weren’t very many from the standpoint of an MD. They were all from a Master’s through a PhD-level clinician, but super helpful, so I read everything I could. There were several that outlined where it started, who would you like to not see and why, and really getting to know and understand exploring. What do you love? What do you not love? Why would you not like to see certain patient populations, and realizing that most of that came down to I think we sometimes think we should be able to see everyone but realizing that a lot of it comes down to what can you do within a single person private practice, instead of maybe a multi-systemic place where maybe some people who need more of those groups of clinicians to be able to experience their ideal health care that needs to happen in a different setting. And so I got every book I could, and then the business aspects were harder because I didn’t have a great place. Now there are more resources for physicians wanting to learn the business side of medicine or just business. At the time, I either couldn’t find them or I just kept landing in very difficult and challenging concepts, but I do remember the morning that I opened, I had a credit card running machine. And I called my best friend from medical school who had been doing private practice for a long time in Chicago. And I was panicking. I said, Mark, I don’t know how to run the credit card machine. What if I can’t run the credit card machine? He said he will take down the number, we will figure out how to key it in later. And I’m like, I’m looking at this thing. And I don’t know how to do it. It was unbelievable. I sat there thinking, Okay, I’ve worked in prisons, I’ve worked with very high-risk populations. I’ve worked at Bellevue, and a credit card machine is going to take me down this afternoon. The other thing I eventually did was start compiling just a document about this is what I have found, in my years of experience. This is the process by which I set up. And I will talk with anyone who wants to talk about setting up a private practice in their statement. Granted, I don’t know different state rules, but most of the time, it’s very similar because I had cobbled things together. I felt like, “Goodness, I would really love to have another mentor guiding me through this process.” It was a lot of nerdy research. Research and panic. That was the cycle.
Sanjula Jain 14:27
You need a bit of both, right? It’s always the little things. That’s very well said and, no matter what the context is, a lot of people go through that if anything new, you just figure it out as you go. You’ve mentioned this idea of imposter syndrome and one of the themes in your life being people telling you, “No, you can’t do that.” In some ways, that must drive you at your core, but it’s a common thing that women in particular face, especially women physicians. Tell us a little bit about how you’ve navigated. I’m sure you have several stories of the unique experiences you’ve had just by being a female, but how have you navigated some of those instances?
Stephanie Hartselle 15:08
I was known within my family for being really stubborn. And if I decided I wanted to do something, and especially if someone told me I wasn’t going to do what I remember my grandfather, who died many years ago, but I had a lot of respect for him. He only had a seventh-grade education but was really bright. He had grown up in the south. And we had very opposite views, even when I was seven, about all kinds of things. And we would get into discussions and arguments at seven. I mean, I was summoned. So would he take me down in every argument? Absolutely. But I also, I remember being about seven and a half, and it was, you know, during the holidays, and he looked over at me, and he said, your stubbornness will serve you? Well, it drives me crazy, but it will serve you well. And I think that the fuel, the accumulation of those, those inspiring words did help me over the years. We owe so much to the women in the generation before us and the women in the generation after us. The idea that we have to do as much as we can to change the narrative going forward for the women who follow. And especially I think the women of color who follow who are encountering even more obstacles. How can we make sure we give a hand up to anyone who is younger in the path, even if it’s not age-wise, even if it’s just career stage-wise? And so really making that part of the ethics and values I revisit every six months or so am I What am I doing to make sure that I further these causes? Especially with women in medicine. How do I amplify the voices of women of color in medicine to make sure that our obstacles are lowering, eventually?
Sanjula Jain 16:55
Your story alone is going to play a big role in advancing that next generation to show them that there are unique paths. To that point, not only are you a phenomenal clinician and have built your own practice, but one of your clients is Netflix and Warner Brothers. Tell us about how that came about.
Stephanie Hartselle 17:16
I have my hobbies and pastimes in a way that I relax and enjoy myself. I have these high-minded literary readings that I do by myself and with my friends. I do read but honestly, in the last few years, especially with high-stress jobs, my default was and the streaming shows the media used to be movies, and actually, it’s less so now I think the amount of amazing work that’s being done for streaming media has been incredible. And so I consume so many shows, so many shows, and it’s part of I give several different types of lectures at Brown University in the medical school, but the main ones that I give usually incorporate clips from different movies all the way back from I think the oldest movie that I use is was filmed in the 1940s all the way up to contemporary shows and movies, but illustrating the way that personality disorders or mental illness and wellness are portrayed in the media, so I’ll show a clip and we’ll discuss. “This is what they’re trying to get out. This is what they think was right. This could be a present. This is where I wish that there was a little bit more dignity, respect around how this can manifest and other ways presented.” Oddly, several years ago, one of the medical students was a good friend of an assistant director in Hollywood, and I was emailed by a company stating that they were making a movie and they wanted to get my perspective on character development. At the time, one of the first ones was birds of prey, which is based on comic books and has Harley Quinn and all of these people I did not know at all. Initially, I remember looking at my husband and saying, “I think they want my opinion on a documentary about birds. I don’t understand why. Is someone researching birds? Maybe they need to understand the person’s drive?” He looks at me and he’s like, “This is a comic book.” I was like, “Wow. Why would they want my opinion on this?” He’s like, “They probably don’t know that you don’t know anything about them,” and I don’t, but it was this really amazing connection. I got to speak with the director, which was awesome, and I got to talk about the characters in that movie and how they might have experienced some trauma previously in their life and how it might have manifested and the way she wanted to shoot the film. It was fascinating. Out of the gate, I had to warn her I literally don’t know anything about comic books. It’s funny because since then, oddly, the things that I’m called on are typically science fiction and also comic book movies or stories or shows to the point where I continue to have to ask my husband and my sons, “Oh, is this character DC or Marvel?” They’re so exasperated and say, “Mom, we have gone over this.” They made me a chart. They laminated these Marvel and DC comic book characters. They don’t usually ever interact. They’re different universes, so I have to refer to the chart. It’s very cute, they draw me pictures. In some ways, I think it’s really neat because I don’t have experience or understanding of the characters. I have the writers and then they’ll get scrapped. Sometimes I speak with the directors. The producers describe to me what they know about what they’d like to understand and portray in the film or the show. It’s really great because people are so passionate about these stories, so I get excited about the stories I never grew up with. It’s been an incredible learning experience. And I think also the fact that I don’t have historical perspectives on what I think these characters would be doing might be an advantage. I’m making that up because I keep having to refer to my laminated chart.
Sanjula Jain 20:55
Little did you know, from those early med school days setting flashcards of neuroanatomy, that now you’re setting flashcards and Marvel characters.
Stephanie Hartselle 21:03
It’s really stunning. It’s been really great. I get to look over scripts and one of the main things I really love are parts of it that are nerdy and exciting just because I love shows. It’s so exciting to speak with people who are involved in these. But also what’s really wonderful is that the media has been incorporating more and more aspects of mental health and psychiatric issues in shows. They really, for the most part, are dedicated to doing it in a respectful and knowledgeable way. That’s some of the parts I’ve really tried to work on is being the voice of this does manifest this way, how you wrote it, there are problematic aspects over here. And so let’s describe what the range is, and how we can better and more, in a more dignified way portray this. And in 99% of the cases, they’re incredibly responsive, and I’ve been so impressed with that. And so that part does feel like I’m giving back a little bit to these kids and adults who are watching these things, and maybe seeing themselves reflected in characters and hoping that they are not seeing something that is disparaging to them. So that part’s been really amazing. But overall, it’s also just like, nerdy and dorky and I love it.
Sanjula Jain 22:18
That is so phenomenal and unique. You wouldn’t think that niche existed, but it’s not just entertainment, it’s education because so much of our influences in society are what we watch. To your point, your career path was in part inspired by watching a television show.
Stephanie Hartselle 22:36
Full circle. I sent a letter to Alan Alda who played the main character on M*A*S*H. I’m sure he gets these letters. I’m sure he has a burst career all the time, and I did not expect anything back, but I just said, “You inspired me to become a physician and I now work in psychiatry.” His character really had. It is kind of funny to think about the fact that this has been a theme since I was five.
Sanjula Jain 22:39
I love that. My favorite show is Grey’s Anatomy, but it didn’t inspire me to be a clinician. What is your favorite movie or TV show these days?
Stephanie Hartselle 23:15
I have so many. I don’t tend to watch things over and over again, but the BBC version of Sherlock I will watch over and over again. They are episodes where I love the timing. I love the pace. I love the scripting. It was done so well. The actors in it are amazing. I tend to stay away from not always but psychiatric documentaries and I will watch shows certainly that have a scientific flair to them. There are parts to it that if I do it all day, I can’t really do a lot of it in the evening for my relaxing time. The first couple seasons of Handmaid’s Tale. I was a big fan of that book and watching it was fascinating. I thought they did the first season so well and reflected the book, which I don’t think happens very often. And so and even now that I’ve been doing consulting on science fiction, I think the first season of Westworld is something that I will watch again and I do use in my lectures.
Sanjula Jain 24:12
Most people trying to break into Hollywood have to go through an agent and here you are just teaching in the classroom with videos.
Stephanie Hartselle 24:19
Apparently! And then thinking I’m going to consult a documentary about birds.
Sanjula Jain 24:27
To that point, what advice would you have for other physicians, let’s start there who are maybe looking to apply their clinical training to a non-traditional, non-patient bedside application?
Stephanie Hartselle 24:42
I’ve been lucky enough to know quite a few people who are physician writers and fiction and others who also consult on scripts and things. A couple of things: continue to do what you love. If that is writing, publishing, podcasting, those are the main ways to continue to produce what you love. It also gives us a second aspect to our lives because medicine can be so all-consuming. I think self-publishing and putting out a blog, or different ways to reach different people, I think is an incredible way to expand your audience and make connections. And I think getting to know other people in the industry, and it may not be because Hollywood is definitely difficult. I don’t live in Los Angeles, but even within your own specialty and speaking to people, often what happens is people are like, Oh, actually, I have a friend who is working on a movie, they might want to speak with you, and that kind of thing. And so and then finally reach out to people that you think are doing work that you really think or think is amazing. And quite often, not always, but quite often people will want to speak with you about how to help bring you into areas you’re interested in. Because I think we don’t have enough. And I think that people who are at graduate levels in different areas, they’re needed, you know, this, this cross-referencing of our knowledge, I think will become more and more important.
Sanjula Jain 26:08
Thinking about the reverse of that, my personal philosophy is that a lot of the things that we’re thinking about in healthcare, the future is going to require a lot of interdisciplinary outside industry perspective, so to speak. Based on your experience in Hollywood, how is that informed maybe your approach to the clinical side and patient care and how you’re thinking about things on that front?
Stephanie Hartselle 26:31
I think it has. Medicine becomes so as you go forward and all of these things you can get very, very deep in your narrow specialty. Generally, medicine is an enormous specialty, psychiatry is an enormous specialty, but you can get very particular and narrow. And I think continuing to invite perspectives, understand things, especially from your patients and the people with whom you interact. I do find that these things, I have a better connection with folks who are watching things, and I’ll ask for suggestions. We’ll have ways to talk about health and mental processing and things because we have a commonality, and discussing what they liked about a show. Also, just be curious about the world. It was really hard because certainly the imposter syndrome and not wanting to be rejected and things, but reaching out to people who are doing work that you find fascinating. And especially I think women who are doing work that you find fascinating, it definitely can result in a non-response or someone not being as helpful as you’d like. If you persisted, I think that so many of us would like to help others along and help them develop their amazing interests.
Sanjula Jain 27:46
In addition to the many hats you wear—Marvel character expert, psychiatrist, and all of these fun things—you also wear the hat of being a mom. What advice would you give to other female physicians who are juggling the unpredictable nature of clinical schedule and raising a family?
Stephanie Hartselle 28:05
A couple of things really play into being a parent and being a mom, as this stuff goes forward, we, when you are involved in a terminal degree like MD and Ph.D., you have to develop a certain amount of I think perfectionism and really control over your environment because the things that can go wrong do go very wrong when they do. Watching that malignant person’s perfectionism that can erupt because children are so unpredictable, parenting is so unpredictable. And it really brings this new aspect to your life where we work so hard and we try so hard to be excellent physicians and excellent caregivers or researchers or whatever we’re doing. And what I found is that and I know people say this all the time, but it is hard to do everything as well as you would like to do. And speaking now directly to the women and moms who feel like they doctor better than a parent. I am one of these people. I am with you. In some ways, my husband is definitely much more the primary parent. I love my kids, I love spending time with them, but I don’t go with the flow as well as other folks do. The ability to radically accept my skills and my abilities with my children and to know that there are parts that my husband does better and they’re not. We don’t have a very traditional role set and that it’s okay it really is okay because I feel like people are like, “How do you do it all?” I do my best to shut my phone off at night and I do my best to spend dinner with my kids. Honestly, my dinners are chaotic. I have the phone at the table. I’m texting patients and I’m often on calls. My kids know this. It is not perfect at all. I fall short in terms of what I wanted to be as a mom constantly. It’s okay. Your kids will be okay. They are seeing different ways of interacting with the world. They know your job is important. They also know they’re loved. And so what you’re doing, even if you feel like you are not the mom, you always wanted to be or thought you could be or you know that’s just not your primary talent, it’s okay. I’m with you, ladies!
Sanjula Jain 30:24
Thank you for sharing that. That’s so powerful and such a great reminder that there isn’t one mold or traditional role that we all have to fill. You just figure out what works for your family and your circumstances and you figure it out, and it works out just fine.
Stephanie Hartselle 30:38
We have a jar for therapy for my kids and I just put money into it. We will get there. Whenever you need to go, you just go because I hear you.
Sanjula Jain 30:52
Another theme of your life really is that people have told you “no,” and you have persisted through that. Is there something you believed early on in your career, whether it was something that someone told you or just some belief system that you had yourself that you no longer believe?
Stephanie Hartselle 31:09
Initially, people would tell me “no” and I’d say, “Watch me. I’ll get this done.” I thought there was one main highway to your goals and it was the way that everyone else had done it. And if you aren’t able to get there and really achieve on that same highway that everyone else is achieving, you won’t be able to make your goals and that has changed over the years. I do feel like I can really, at this point, see different routes to making what I want out of my life and my career. Find people who are interested in brainstorming with you in creative ways and curious ways to get to the places you can be. Keep believing in yourself that you really can. There are all kinds of routes to your goals. If people tell you no, there’s a way. There really is a way.
Sanjula Jain 32:04
That’s beautifully said. Last question then, as we like to ask all of our guests but I’ll modify it for you: You have many more scenes to write in your movie, but what would be the title of your documentary or film of your choosing?
Stephanie Hartselle 32:19
Oh, good, Lord. The main theme is always just kind of like— This is so sarcastic. “Oh, yeah? Watch me.” It’s sassy! I don’t know. It’s really just don’t let other people limit you. You only do this once. If you don’t have lofty, enormous goals, it’s okay. Being happy and content and at peace are the most meaningful parts and having love in your life.
Sanjula Jain 32:46
Absolutely. I love it. Thank you for all that you do and for blazing this uncharted territory for other women physicians out there and for opening our eyes to creative applications for this kind of skill set. I’m excited to start scrolling the film credits to look for your name on future movies, so you’ll have to keep me posted on what’s in the dock.
Stephanie Hartselle 33:09
I will, I will.
Sanjula Jain 33:10
Thanks, Stephanie. Appreciate it.
Stephanie Hartselle 33:12
Sanjula Jain 33:14
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