RACP — Kia ora, Kia ora, David and welcome to the RACP Aotearoa NZ Specialists Week. Thank you so much for talking to us today. Can you tell us a bit about yourself, your background, and what you do?

Dr David Newman — Thank you for the opportunity. I am a general and developmental paediatrician, and am approaching retirement, so I have quite a long and broad perspective on my medical career. I trained at the University of Auckland Medical School, and then in Paediatrics at the Princess Mary Hospital, which was before Starship Hospital was built. My first consultant job was working as a locum in West Auckland, as well as doing locum acute work in Middlemore Hospital.

After this I went to Brisbane to work at the Mater Hospital to do further training in developmental paediatrics and from there I got my first full-time consultant job in South Australia at Port Augusta, approximately 300km north of Adelaide, so rural and remote medicine. We had two paediatricians and a registrar on a one in three roster covering approximately two times the land area of NZ with about 150,000 people in it. It was an incredible experience.

In 1998 I came to my job here in Hamilton and have been based here ever since doing general paediatrics, developmental paediatrics, and outreach clinics across the Waikato region. I have been the head of department here and have also had the privilege of being both a regional representative and also the President of the NZ Paediatric Society.

What inspired you to become a doctor, and then a Paediatrician?

I was always very interested in Biology and Sciences and ended up following many of my classmates and peers to medical school. My initial direction would have been going into Architecture like my dad, but once at medical school I really got into medicine and did consider surgery, but paediatrics was so interesting given the exposure to such a wide range of sub-specialties. Neurology was quite attractive to me, and developmental paediatrics involves a lot of neurology, so I have had the opportunity to do the full range of paediatrics. I have done a lot of acute call work supporting our intensive care colleagues, as Waikato don’t have a specialty paediatric intensive care unit, so they rely on us for support and liaison with Starship Hospital. Subsequently I have been able to focus more of my developmental work in the Child Development Centre, and I have several clinics there weekly. I have a strong interest in working with kids with neurodiversity and enjoy being able to help children and families understand and support their young people through the process of diagnosis as well as appropriate identification of a range of health issues. Developmental paediatrics requires a fair bit of psychiatry and the ability to work across multi-disciplinary teams.

What are some rewarding moments in your work?

What is probably the hardest part is when you encounter kids who are not going to live a long life, and being able to walk alongside whānau as they address the mortality of their child brings out the art and humanity of medicine. Whilst this is difficult, it is often the most rewarding part of the work that we do, as this is where medicine brings out the best of us as human beings.

What does a typical day look like for you?

Well, I no longer do acute work, so I am doing mostly developmental and neuro-disability work. I run four clinics a week, half of which are supported by a registrar or Fellow, which also provides training opportunities in the neuro-developmental setting. We also run combined clinics with a psychologist and a paediatrician for first specialist assessments where we try to make the most progress, the most definitive diagnostic formulations that will help whānau,  schools and the community around them help make progress, rather than doing one thing, waiting on a list for another thing to be done a long time later, and putting things together slowly.

From your medical perspective, what are the big issues facing young children and adults?

I think equity, relative poverty, and access to services and supports are key issues. If you have got parents and primary care educators who know how the system works, you can get through the system without too much delay. But otherwise, parents and caregivers are faced with significant delays in receiving care. We live in a world where people are more likely to seek a diagnosis from what they can find on Google, or discuss with the neighbour over the back fence, so it is vitally important that we create that equity of access, especially to rural and regional areas.

Do you see an increase in trainees coming into community child health, or is there a shortage?

Community child health requires specific, additional criteria on top of general paediatrics, and that can complicate training for some, particularly for our female colleagues who are having families or need a more flexible way of completing their training. However, community child health enables people to understand the breadth of community contributors to disease, disability and deficit, and can be extremely valuable, particularly for clinicians working in smaller centres.

What sort of characteristics do you think you need to work with children?

One has to be prepared to listen, watch and try not to interrupt. There is a factoid that most patients get interrupted by their doctor within ten seconds of their consultation, but children require a lot more observation. They won’t tell you their problems, so you have to watch, listen and work with their families to get as much information as possible to avoid unnecessary assumptions and missing something important.

Do you have much use for AI or other tech?

We rely on tech a lot for things like electronic prescribing, electronic growth charts, electronic messaging and requesting systems, all of which are significant enablers in the nature of our work. However, AI is yet to really impact on the front line in any substantial way. It will definitely be a tool that will facilitate the documentation of consultation in a more reliable way. I have colleagues in private who use AI tools such as Heidi AI and they find that it makes their documentation much quicker and more reliable. All of this still requires human touch, as AI is just a tool.

What do you do to get away from medicine or maintain a healthy work-life balance?

Being with family, walking on beaches, photography, socializing with friends, good music, gardening, fixing things and doing small projects. Work-life balance is so important, and I think many people of my generation have worked in a way that was not so good for us, with too much focus on meeting others needs that has resulted in many cases of burnout, which is not good for us, or our relationships, or our effectiveness as doctors.

Self-care is vital. I am a great advocate of being in long-term personal supervision to ensure that we address issues around being accountable to ourselves and our families, outside of our careers. Newer consultants appear to better at ensuing that they establish boundaries between their person life and their work life.