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RACP: Kia ora, Dr Kim and welcome to RACP Specialists Week. Thanks so much for taking time out of your schedule to chat with us today. Can you tell us a bit about yourself?

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RACP: Kia ora Dr Douglas, thank you for finding time to speak to us today. Please tell us about yourself and your background.

Dr Douglas: I’m Nick. I’m 43 years old. I grew up in Christchurch, then left for varsity in 2000. I did a little bit of clinical training here in Christchurch, but I’ve largely been overseas for the last 20 years, a bit of time in the UK but mostly in Darwin, in the northern part of Australia. My current position is infectious diseases physician in Christchurch, but I also have roles with the University of Otago Christchurch Campus and with Menzies School of Health Research in Darwin, Australia. My academic activities include teaching medical students in their clinical years of training, as well as postgraduate students; I have three PhD students at the moment. I also conduct research. My areas of particular interest include malaria and leprosy. Our main collaboration with the leprosy work is with the National Leprosy Unit in Kiribati.

I have two kids – eleven and eight years old – and my wife also works as a neurologist here at Christchurch Hospital, so we’re fairly entwined in the medical world.

RACP: What got you interested in medicine and specifically in infectious diseases?

Dr Douglas: The event that made me acknowledge my interest in medicine was a teacher in intermediate school asking me “Hey Nick, have you ever thought about being a doctor?”. We were on a school camp in a place called Craigieburn, about an hour and a half away from Christchurch. As a class, we were climbing a little mountain, and as part of that we were running down a scree slope, and a friend of mine fell. He gave himself some nasty gashes on his legs, and I remember being very ‘in there’, wanting to help patch him up. I found it all very interesting and I was very pleased to be able to help him out, and my teacher mentioned to me afterwards that I should think about becoming a doctor.

I put that thought to the backburner, because I didn’t think I would get into medical school. I then remember having an important conversation with my dad a few years later, who knew I was interested in medicine. He said to me that “if you put your mind to it, I’m absolutely sure that you’ll get in”. It was really nice to hear that. I ended up putting my mind to it and sure enough, I got in.

In terms of Infectious Diseases specifically, I just find it really fascinating. There’s a lot of super interesting diseases, and I enjoy the interaction between the human world and the animal world. A lot of the tropical pathogens have really quite complex and highly evolved interactions with humans. I like that you can generally ‘fix’ people as well. It’s nice to be able to see people and say, “we think we know what’s going on and with treatment we should be able to cure you”. Generally, that comes true. I like the extensive interactions we have with other specialties around the hospital. We are primarily a consult service, so we spend a lot of time interacting with colleagues from all sorts of different specialties: surgeons, physicians, GPs and psychiatrists on occasion.  Building up good relationships with all these people gives me a lot of pleasure in my job.

RACP: How does infectious diseases practice in New Zealand compare with elsewhere?

Dr Douglas: Every place in the world has its own standard set of infections, and regardless of where you are, that becomes your bread and butter. If you were in Ethiopia, you’d see malaria day-in, day-out. It would be a very uninteresting condition for you after a while, but a prosthetic joint infection might be unusual. In Christchurch, where I am, it’s definitely a big enough place that there’s a steady stream of people coming back from overseas with all sorts of conditions that are not endemic here, so there’s no shortage of exotic conditions to spice up the case mix.

Even in the stuff we see day-in, day-out, there is satisfaction in feeling like you can treat the condition effectively and efficiently.

RACP: What does a typical day look like to you?

Dr Douglas: There is a lot of variety, which is one thing that I really like about my job. A standard day might include an outpatient clinic, some inpatient consults or a Clinical MDT in the bone marrow transplant unit or ICU. I might have a research meeting with one of my PhD students and perhaps a bedside tutorial or lecture with the medical students. If time allows, I often try to do some manuscript editing or writing. A mixture of clinical and university work keeps things really interesting, but the workload can sometimes feel a little overwhelming.

RACP: What are some of the challenges infectious disease specialists face?

Dr Douglas: There’s the very well-known issue of antibiotic resistance. What that does for us is create this tension between treating the individual patient in front of you, versus protecting populations from antibiotic resistant organisms. I don’t think there are that many specialties where you have to think about individual benefit and population benefit at the same time. We’re always trying to reduce the usage of antibiotics, but when you have someone who is septic in front of you, it’s very hard to maintain a focus on population-level effects. There’s no doubt that antibiotic resistance is progressing, so our range of top-shelf antibiotics is diminishing as we go along, and antibiotic production is not keeping pace with progressive resistance at the moment.

Another issue is the huge amount of progress made in molecular diagnostic capability in the lab, with increasingly sensitive multiplex tests. Our knowledge of how to interpret those tests is lagging behind the actual technology. There are bugs everywhere in our bodies and in the environment, so trying to figure out which ones are important and which ones aren’t is becoming increasingly difficult as tests become more sensitive.

At a service-provision level, some of the smaller peripheral hospitals are really struggling to access specialist infectious diseases input, whether that’s phone consultations or in-person reviews.

RACP: Is AI used much in your work?

Dr Douglas: Infectious Diseases as a specialty is heavily focused on the quality and comprehensiveness of the history. I do not think that the specialty will be replaced by AI, in the near future at least. Having said that, there are examples of how AI is helping. One area that is close to my heart is diagnosis of malaria. Typically, the way you diagnose malaria is to do a finger prick, put a spot of blood on a slide, spread it out then look at it under a microscope to see if the parasite is present in any of the red blood cells. It’s pattern recognition, so there’s encouraging evidence that if you take quality photographs through a microscope of the slides, you can get a computer to tell you whether malaria is there. AI might have some uses, but in terms of clinical diagnosis from patient interactions, I think it’s a while away.

RACP: What differences did you find working in Australia compared to New Zealand?

Dr Douglas: Different diseases. In Darwin, they had some reasonably unusual infections because of the tropical environment. One of the common causes of pneumonia there is Melioidosis, caused by Burkholderia pseudomallei, which is a bug that lives in wet soil in warm environments, and has quite specific treatment protocols.

Largely the systems are pretty similar. One thing that I noticed was that there was access to a much more extensive range of anti-infective medicines. In New Zealand, we’re more restricted in terms of what we can use, and in general I think appropriately so. There were also differences in cultural aspects of care there. Darwin has a very large aboriginal population with unique health needs that are not always well-catered for by the western medical system.

RACP: What would your advice be to trainees or medical students considering a specialisation in infectious diseases?

Dr Douglas: I get approached by students and junior doctors interested in Infectious Diseases quite a lot. I think there are lots of opportunities for students to get involved in infectious diseases and global health work within their electives, so I often suggest they explore their interests further during these placements. I encourage them to go to places with really different health systems and different diseases to New Zealand. I love discussing all the benefits of Infectious Diseases that I mentioned before. I also try to be honest about some of the potential downsides. Infectious diseases is not a specialty that lends itself well to private practice so earning potential is not a big drawcard. It’s also not a good specialty to do if you’re keen on keeping up a regular procedural component to your work.

RACP: What do you do to de-stress or relax?

Dr Douglas: I really like the mountains, and Christchurch is a great place to work for access to wild places. I love going tramping and I do some climbing as well. I’ve recently taken over responsibility for a stoat trap line at Arthur’s Pass to help with native bird conservation there. I’ve recently joined a small a capella singing group and I’m really enjoying that.

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RACP: Kia ora, Dr Russell. Welcome to RACP Specialists Week and thank you for taking the time to speak with us. To begin, can you tell us a little bit about yourself?

Dr Russell: I am a developmental paediatrician at Starship Children’s Hospital. I finished training in 2020, and immediately was able to join my dream team at Starship. I work 2 days a week at Starship, and 3 days a week at the Ministry of Health. At the end of last year, I started as the Chief Clinical Advisor for Child and Youth. I’m still finding my feet at the Ministry, but it’s been a really interesting time.

RACP: What inspired you to be a doctor?

Dr Russell: My parents! My mum is a GP; she’s in her mid-seventies but she’s still working part-time. She loves it. My dad is a neuropathologist, and my brother is a rheumatologist, so I come from a family of doctors. From an early age, I liked being helpful. I really enjoyed looking after people, and when I finished medical school, I realised that I just loved treating children and talking to families. I continue to just love treating kids, so I really enjoy my job.

RACP: What are some rewarding moments that inspire you to carry on when it’s hard?

Dr Russell: The job is really hard work. We work really long hours at Starship. I think everyone is working long hours now. I can honestly say that doing a day of clinic gives me energy. I get energy from sitting in a room with children and their families talking about their health and their development. I get a lot from that and I go away feeling pretty happy. There’s a lot of paperwork too!

In developmental paediatrics we look after children who have chronic conditions and often there are no easy solutions, however I find it a really rewarding job because when we do make progress for children, even if it’s small, it’s widely celebrated. It’s so rewarding to see children with quite significant disabilities make progress in the smallest things. Whether it's that child that I’ve been looking after saying their first word, or starts walking using a frame, or is able to transition into school, or shows excitement or curiosity about something in the classroom that they hadn’t communicated before. All of those moments are quite magical for parents, and I love being able to be alongside them. It’s very rewarding but it’s also a really tough job. It’s a complex area of paediatrics. We work in multi-disciplinary and cross-agency ways, and we’re heavily interfaced with schools, so it’s a complex but very rewarding area of medicine.

RACP: What would a typical day for you look like?

Dr Russell: At Starship, I do a clinic in the morning. This can be at the hospital, or a community setting, or at a school. Our team runs clinics in specialist schools, and that gives us access to teachers, therapists, SENCOs (Specialist Educational Needs Coordinators). Then in the afternoon, I’ll recover from clinic by doing all the paperwork! I often have meetings online with other agencies, community organisations, disability support organisations, schools and allied health and nursing colleagues. I look after children from birth right through until sometimes age 18 but usually transitioning around the age of 15 or 16.

RACP: What are the big issues at the moment facing children and young adults from a medical perspective? 

Dr Russell: Over the past 20 years or so, mirroring patterns globally, in Aotearoa we’ve seen a really significant increase in the proportion of children who have a neurodevelopmental condition such as autism or ADHD. This is reflected in the New Zealand Health Survey Statistics (2023/24): the prevalence of ADHD amongst children (<15 year olds) has risen from 2.8% in 2018 to 5.3%. For autism, it has risen from 2.0% to 3.0%. That is a massive rise, so we need a lot of paediatricians who are comfortable with developmental and behavioural issues. The Community Child Health training program is a fantastic program in the College, and internationally it’s a really special program. In Community Child Health, we are trained in three pillars: one is developmental behavioural paediatrics, the second is child protection, and the third is child population health. When you look at those three pillars together, you can see that they make a really strong triad for understanding children’s needs in the community. We are in the age of neurodevelopmental conditions in paediatrics, with a massive shift towards developmental and behavioural presentations.

RACP: Do you see an increase in Trainees entering Community Child Health, or is there a shortage?

We are the second largest training program in paediatrics, after general paediatrics. I think the strength of Community Child Health training is well recognised now.

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

Dr Russell: I think you have to be a patient person to be a community paediatrician. I think you need to be able to celebrate small wins and be happy with those small wins, as in Paediatrics they are big ones. What really helps is a sense of delight in children.

RACP: Is there a role for AI in your field? Do you see it increasing?

Dr Russell:  Absolutely. Developmental paediatrics tends to require very comprehensive history taking and appointments. I am looking forward to when we can use AI tools to help us capture and summarise our appointments and help New Zealand. I think that will save us time. I am already using various AI tools in administrative aspects of my job. We’re living in a very privileged age when it comes to technology. I’ve found using AI tools such as Microsoft Co-Pilot very helpful when creating educational resources, or with any kind of communication to families. It's important to have the skills and the knowledge to be able to review and edit properly, but AI tools can help people like me who might find it hard to get started on writing.

RACP: What do you do to de-stress or relax?

Dr Russell: I watch tennis. I play tennis (badly!). I go for runs. I try to take my mind off work. I’ve got two lovely boys – 10 and 8 years old – and they’re so fun, so anytime I get to spend time with them, I can de-stress very quickly.

RACP: Thanks again, Dr Russell for your time and for sharing with us.

Dr Russell: You’re welcome.

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RACP: 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. I am approaching retirement now, 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.

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

Dr David Newman: 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 doesn’t have a specialty paediatric intensive care unit. They rely on us for support and liaison with Starship Hospital. Subsequently I have been able to focus more on 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.

RACP: What are some rewarding moments in your work?

Dr David Newman: 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.

RACP: What does a typical day look like for you?

Dr David Newman: 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 make progress, rather than doing one thing then waiting on a list for another thing to be done a long time later, and putting things together slowly.

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

Dr David Newman: 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 their neighbour over the back fence, so it is vitally important that we create that equity of access, especially in rural and regional areas.

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

Dr David Newman: 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.

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

Dr David Newman: 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.

RACP: Do you have much use for AI or other tech?

Dr David Newman: 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.

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

Dr David Newman: Being with family, walking on beaches, photography, socialising 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 be better at ensuing that they establish boundaries between their personal life and their work life.

RACP: Thanks so much for your time today

Dr David Newman: You’re welcome.

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RACP: Kia ora, Catherine and thanks for making time to talk to us as part of Aotearoa NZ Specialists Week.  Could you tell us a bit about yourself, your background and what you do?

Dr Catherine D’Souza: I am originally from the UK and had my first consultant job at Oxford University Hospitals in the Palliative Care unit there. I came to Timaru in 2018, which was a big change coming from a huge tertiary referral hospital to a small rural area. I am married with two children.

RACP: What got you interested in medicine and more specifically in your specialist area?

Dr Catherine D’Souza: I initially wanted to be a psychologist, then through some volunteer work experience with homeless people I decided I wanted to work in Psychiatry and mental health, as I was very interested in how people tick and how I could help them psychologically. However, I found that I had more of an interest in doing that through Palliative Medicine, than through Psychiatry.
I also enjoyed every specialty area that I worked in, such as surgery and the medical specialties, but I wanted to work in an area where you were involved in everything about the person, not just a short interaction, or about a particular part of the body, so Palliative Medicine was a brilliant way of caring for a person and making a big difference to them and their whānau

RACP: How did you end up moving from Oxford to Timaru?

Dr Catherine D’Souza: Well, I got a job offer out of the blue. I hadn’t applied for anything, but somebody had got my details from another palliative care unit in Nelson where I had been previously looking at jobs. When I received the job offer I had just done a 3 hour commute through terrible traffic, and I thought a move to New Zealand sounded like a good idea. It was never meant to be permanent, as I just wanted to come over and see what the other side of the world was like, have a bit of an experience while the kids were young and maybe move back, and then I didn’t move back.

RACP: How is the experience living in Timaru?

Dr Catherine D’Souza: It’s great! Everything is so easy, there is no traffic, I pretty much cycle everywhere, I cycle to work, cycle to get the kids from school, so I have much more time with the kids being in a small town as opposed to being in a big city where I would spend an hour each way commuting to work. Another benefit is that I know all of the doctors here, so referrals and interactions with other consultants and GPs is just so much easier.

RACP: What are some of the challenges you face working in a rural setting?

Dr Catherine D’Souza: There are some obvious workforce challenges, as here I am the only palliative care specialist, and they hadn’t had a consultant in palliative care before I arrived. Also, we are currently working with about half the number of RMO’s that we should have, so that spreads everybody very thin.

When I first came here there was no out of hours cover for my inpatient unit, so I was pretty much on call for the first few years until we could set up an on call rota. However, the benefits of really being able to get to know your patient cohort, know the communities they live in and know who to call to get help is a brilliant asset of being in a small community. This in turn creates a greater degree of flexibility in what you can do for people. In some of the bigger units I have worked in you are often trying to get through a system to find someone to help you, whereas in a smaller setting we have more collegial ways of getting on and getting things done.

Another challenge we face is the difficulty of taking leadership opportunities when you are based in rural settings. Due to the smaller size of teams and the broader range of responsibilities, it is so much harder to get away from work, and at the same time it takes longer to travel to places such as Auckland for key meetings etc. Because I came from a big centre, taking on leadership roles was part of the culture. But I have noticed you do tend to get treated differently if you are from a small place, or assumptions are made about what you may or may not be interested in or good at.

RACP: What does a typical day look like for you?

Dr Catherine D’Souza: I work in a multitude of settings, I work in a hospice in-patient unit, and I usually start the day by getting a handover of how the patients have been overnight. Then I might move straight on to an outpatient clinic or over to the hospital to do some liaison work. I see patients on the general medical or surgical wards, mostly for symptom management, then I might head out into the community to do a home visit. I spend a lot of time giving clinical advice to other specialties, such as medical consultants, surgeons, GP’s, district nurses etc, I am on the phone a lot to them.
I do a lot of teaching with local doctors, junior doctors, medical students and also teach in care homes. I also teach carer skills courses, which shows carers how to look after people who are terminally ill, and I also teach a breathlessness management course.

RACP: Do you have much to do with AI or tech applications in your work?

Dr Catherine D’Souza: Not really. I don’t use any AI for note writing support, as I have a support staff member that looks after that. It’s something I be very interested in using in the near future.

RACP: What do you do to get away from your work or maintain a good life work balance?

Dr Catherine D’Souza: When you have two young children you need to take time out to manage family life, so they absorb a huge amount of my after work life, and that is wonderful. Alot of my hobbies involve my children as well. I am in a beautiful area of the country, and I am a keen cyclist. I participate in an annual 360 km sponsored charity bike ride over three days, which is fun and keeps me fit. I also cycle to all most of my home visits!

RACP: What gets you excited in your day-to-day work?

Dr Catherine D’Souza: I have an amazing team at the Hospice, and it is a cool place to work. I enjoy being part of a very caring and supportive environment. The job I do involves very challenging circumstances and emotions. Supporting people through difficult times is tough, but by having a wonderful team who bring light and laughter to people and their families is a real joy.

RACP: Does the nature of your work take a toll on you personally?

Dr Catherine D’Souza:  When I was in a single handed medical team, with no other medics in the team, I felt the toll of responsibility being in charge of very complex medical and emotional situations without other doctors to share the load with. It was exhausting when we had no out of hours cover and I was responsible for the inpatients without any days off. It was a huge relief when we finally were able to set up an on call rota. It definitely requires a really strong multidisciplinary team to support each other to keep you going and I am grateful for the team I have here.

RACP: Thank you so much for your time today.

Dr Catherine D’Souza: No problem at all.

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RACP: Kia ora Dr Matthews, and thanks so much for taking the time to chat with us today. Could you tell us a bit about your background and what you do?

Dr Tim Matthews: I am a General Physician who has always worked in the smaller, provincial hospitals space, for example hospitals where there are specialists, but small and limited numbers of them, generally across a reasonable range such as surgical services, anesthetics, paediatrics etc. I have been a General Physician, but as a registrar I did geriatric training. I came to New Zealand from South Africa in 2000, having worked as a General Physician in a provincial town where there was a massive burden of HIV and Tuberculosis, so I did a lot of chest work at that time. But coming to New Zealand and to the Wairarapa, the scope of my work changed, and I started to do a broader range of acute work as it arose, but it relies heavily on support from tertiary specialist colleagues, for example things like coronary angiography and stroke clot retrieval therapy. About two years ago I exited acute on-call general medicine, and I am now working in ambulatory care, such as hospital out-patient clinics and geriatric services. This requires a lot of liaison work with GP Practices almost every day of the week, so I have a lot of travel around the region. I thoroughly enjoy my work and feel that my current workload and configuration is at a really sustainable level.

RACP: What got you interested in medicine initially, and then into Geriatric Medicine?

Dr Tim Matthews: I grew up in a farming community in South Africa. My mum was a nurse, but I was inspired by the local GP and thought at an early age that I wanted to be a doctor, so I headed off to Medical School. In South Africa at the time, we had conscription, so I worked as a doctor in the military for two years and this experience made us all quite career focused when we got out of the military. I was initially interested in anaesthetics but got pushed into an SHO job in an ICU and from there got interested in internal medicine. I have always been fascinated by understanding sociology and how humans are part of that across the age trajectory. The community I grew up in was very inter-generational in the way that we related, and we weren’t so intimidated by older folk, so I always found their stories fascinating. Geriatric medicine gave me a nice blend of that human interest side, but with plenty of general medical knowledge required to understand the whole field.

RACP: Does living in the Wairarapa feel like your comfort zone, in a rural setting?

Dr Tim Matthews: Yes, definitely. I live 200m from the hospital, so I have no commute or any such issues. We actually settled in Masterton through a locum agency and have always been happy living here. Masterton Hospital is a wonderful place with dedicated staff, lots of innovation and a strong culture of clinical care excellence.

RACP: You mention innovation being essential in small rural hospitals. Do you all feel like the Swiss Army Knife of medicine?

Dr Tim Matthews: You need to have a pretty broad skill set, but we are not shy about reaching out to colleagues in bigger centres to sort out more complex medical issues. In some ways I feel like I am a ‘Health Broker’ working in rural health, and I have always found my colleagues very generous with their help. Overall, dealing with a broad scope of medical conditions is quite exhilarating, but it can wear on you as it can be very demanding.

RACP: What does a typical day look like for you?

Dr Tim Matthews: At the moment I am quite out-patient based, with clinics on Mondays and Tuesdays, Wednesdays and Thursdays I have community based outreach, and each of those days I meet with community based GPs. As a Geriatrician, I do a lot of home-based visits, alongside a specialist nurse, and I also have a lot of admin, especially referrals triage. On a Friday, I do procedures, especially with Oncology and Palliative Care. My work is very clinically oriented week to week.

RACP: Currently the College is working on the implementation of the Rural Regional and Remote Physician Strategy. What do you think are some of the challenges facing rural and regional medicine in Aotearoa NZ?

Dr Tim Matthews: We are always going to feel under-resourced, but the people who come to work here really enjoy it, so I guess the trick is always getting them to stay. Work satisfaction and lifestyle are both excellent, but maybe it comes down to what the actual family needs are, which are quite often better met by urban centres. We also need to develop technology to manage patients in tech-solution ways, such as what we do with multi-disciplinary cancer work, and better utilize a more nurse-led type of practice, for example neurology are using nurse specialists more and more for their Parkinson’s and epilepsy work, and renal clinics are being staffed by nurse-practitioners. I am definitely seeing a shift in that way of practicing. We also have a number of NZREX doctors who carry out clinical work, which really helps.  One of the challenges of being in a smaller place is that you don’t have big teams, so for example, if you want to develop a stroke service, which is an area I have been involved in, you’ve got to do it yourself and be pretty determined about improving those services. In my 25-year career here, I have been inspired to develop TIA clinics and stroke services but have now moved on from that work, now that there are good systems in place such as tele-stroke services that provide a good, fast service. I am now involved in a research project with Otago University looking at stroke rehabilitation with Māori patients, and this kind of work is very satisfying for me as it keeps me involved in stroke medicine but is also more community based.

RACP: Do you have much interface with AI or other tech applications in your work?

Dr Tim Matthews: I have actually just recently started using AI for transcribing consultations and have been using Heidi AI as an assistant to my letter and note writing. It takes a great cognitive burden away from my work. It took a bit of time to setup but was totally worth it.

RACP: What do you do outside of work to maintain a healthy work/life balance?

Dr Tim Matthews: I have always been keen on sports and always did a lot of running, but nowadays mostly hiking and swimming. About two years ago I felt a bit overwhelmed by the range of work and pressure, so my new role is sustainable and works really well. Younger colleagues have stepped up and this has helped the team. Our younger doctors are more skilled at setting the parameters of their work and being realistic about workload.

RACP: What gets you excited in your day-to-day work

Dr Tim Matthews: I really enjoy work relating to Stroke, Parkinsons, Motor Neuron Disease, and Neurology. I really enjoy interacting with colleagues, especially in primary care. We have very good communication in meetings and forum settings and I love the idea that we can provide better services beyond the ED doors. I have lived through a very interesting era of medicine for over 40 years of practice, so seeing things like anti-viral treatments, complete changes in cardiology practice and oncology for example have been so amazing.

RACP: Thank you so much for your time today.

Dr Tim Matthews: You are most welcome.

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RACP: Kia ora, Dr Kahlon. Welcome to RACP Specialists Week and thank you for taking the time to speak with us. To begin, can you tell us a little bit about yourself?

Dr Kahlon: Kia ora and thank you for having me. I’m originally from the United Kingdom and am a first-generation British Indian. My parents were raised in India. I completed an undergraduate degree in Biomedical Science at the University of Warwick, followed by a medical degree at Queen’s University Belfast.

RACP: What initially drew you to medicine and what has your training journey looked like?

Dr Kahlon: Honestly, I didn’t grow up wanting to be a doctor. I was always interested in science, which led me to study Biomedical Science. But halfway through that degree, I realised that lab work wasn’t for me. It was actually my parents who encouraged me to apply for medicine during my final year. I was initially hesitant, but applied to four universities and was fortunate to receive an interview at Queen’s University Belfast. The rest is history!

During medical school, I did an elective in Endocrinology at Waikato Hospital, which is when I fell in love with Aotearoa New Zealand. It became a dream of mine to return as a qualified doctor. After working in the UK for two years, I came to New Zealand on a working holiday and started at Palmerston North Hospital. About six months into that trip, COVID hit – and what was meant to be a six-month adventure turned into six years. I’ve since joined the RACP and after 18 months in Palmerston North, I moved to Christchurch, where I’ve been ever since.

RACP: Did you receive any support when transitioning into the New Zealand system?

Dr Kahlon: I felt very supported at Palmerston North Hospital. Luckily, there were five other British doctors who started around the same time, which helped us all feel like we were in it together. I started out as a house officer, and the registrars and SMOs were genuinely interested in supporting and mentoring us.

However, when I joined the RACP, there wasn’t much personal engagement. It was a fairly straightforward sign-up process and that was it. I think a welcome call or an introductory conversation about what to expect and how the College could support new trainees would have gone a long way. That’s why I really appreciated the New Zealand Member Engagement team visiting Christchurch Hospital. They spoke with trainees and IMGs, listened to our experiences, answered questions and just made the College feel more approachable. It was nice to put faces to names within the organisation.

RACP: What led you to pursue training in both Palliative Care and Acute General Medicine?

Dr Kahlon: Palliative Care wasn’t on my radar initially. In fact, I had deferred a GP training position in Liverpool to come to New Zealand. But while working in Oncology in Palmerston North, and often being thrown in the deep end during General Medicine runs, I found the palliative conversations to be some of the most meaningful parts of my day. They gradually became the first conversations I’d want to have. I realised how vital quality of life and dying with dignity are, and I began to form deeper connections with patients than I’d experienced before.

As for General and Acute Medicine, I love the pace, the variety and the team dynamic. You touch on so many different specialties and I think it pairs really well with Palliative Care, especially in the context of an ageing population.

RACP: What do you find most rewarding in your work?

Dr Kahlon: It’s being part of the journey with patients and their whānau. When people feel they can trust you and open up about what they’re going through, that’s incredibly humbling. Being able to listen, support and help them find comfort – that’s the part of medicine I value most.

RACP: What are some of the biggest challenges facing Palliative Care in New Zealand?

Dr Kahlon: Workforce fatigue and burnout are significant issues. There are passionate and capable trainees coming through the system, but often no jobs available for them, despite increasing need. Our population is ageing, yet we lack the infrastructure and workforce in Palliative Care to meet that demand. It’s a growing concern that urgently needs addressing.

RACP: How do you unwind and maintain a healthy work-life balance?

Dr Kahlon: My five-year-old black Labrador, Ollie, takes up most of my evenings. He’s full of energy and keeps us on our toes! I also enjoy going to the gym which is my way of de-stressing. I’m a big sports fan. I’ll watch pretty much anything but I’m especially passionate about football. I support Liverpool FC and try to catch a match whenever I’m back in the UK. I also love catching up with friends over coffee or a good movie.

RACP: Thanks again, Dr Kahlon. It’s been a pleasure hearing your story.

Dr Kahlon: Thank you – it’s been a pleasure to share it. I really appreciate the opportunity.

Read full interview

RACP: Tell us about yourself and your background

Dr Brebner: Ko Alex Brebner toku ingoa. I’m a Public Health Medicine Registrar. I grew up in Tāmaki Makaurau Auckland and went to the University of Auckland and graduated in 2015. I worked as a medical registrar in Taranaki and Waikato before starting my journey in public health in 2020. I helped support the Waikato Public Health Service during the COVID-19 pandemic and then the National Public Health Service Intelligence team before my current role in Te Whatu Ora Improve.

RACP: What drew you to studying medicine in the first place?

Dr Brebner: I was always very scientifically minded, so wanted to have a career that was science related. I was attracted to medicine because it combines the enjoyment of scientific pursuit with the reward of contributing to society in a positive way.

RACP: What drew you to public health?

Dr Brebner: I first entered public health at the start of the COVID-19 pandemic, which was an exciting time because of the rapid pace of change and the challenge of navigating all the unknowns. However, I also like that public health is a broad field, with many different opportunities. What interests me about public health is the ability to make change upstream, so you can make decisions that influence a large population of people. There is a lot of potential to do good. I like the holistic view that is required in public health and the need to understand issues from many perspectives: political, cultural, ethical, scientific, economic and more.

RACP: What do you find most rewarding about your job?

Dr Brebner: The ultimate reward comes from the ability to positively influence the lives of many people. On a more practical level, I have an interest in data analytics, epidemiology and artificial intelligence and love that my job allows me to explore these topics in depth and depend on the technical skills I have in these areas. I also appreciate that my job allows me to think through issues at a slower pace and lets me build strong relationships with a diverse group of peers.

RACP: What does a typical day look like for you?

Dr Brebner: Once I’ve dropped my daughter off to kindy, I return home or bike into the office, make a coffee and sit down at the computer. From there I will mostly be emailing, attending meetings, reading, reviewing and writing documents or analysing data. The range of tasks and projects that I might work on is broad, for example I might conduct a literature review, project manage a quality improvement initiative, help develop a policy, strategy or framework, or perform a cost effectiveness analysis of a new health technology.

RACP: Is AI used much in your work? What role do you see AI playing in the work you do?

Dr Brebner: In my current role, I’m supporting the NAIAEAG (National Artificial Intelligence and Algorithm Expert Advisory Group), so our work revolves around AI. In terms of how we might use AI to do this work, AI is already used day-to-day in ways that we aren’t always conscious of, for example spell checkers and videocall background filters. The rise of generative AI and in particular, large language models, is likely to have a significant impact on how we work, but it’s difficult to predict exactly how. It seems likely that it will substantially impact how we find information, brainstorm, write and improve documents, and analyse data. I think it will also shape the way we learn and in fact, I am currently using generative AI to assist my own studies.

RACP: What do you think are the biggest challenges facing public health in New Zealand?

Dr Brebner: Central to all public health work is the challenge of addressing health inequities and in particular, strengthening the health of Māori and Pacific communities. Additionally, public health has a key role to play in many important challenges, be it climate change, the aging population, delivering health services in a resource-constrained environment or integrating emerging AI tools into health in a safe, ethical and efficient way.

RACP: What do you do to de-stress or relax?

Dr Brebner: For me the formula is pretty simple: spend time with my family, play tennis, do some gardening, blob in front of the TV, and if I get the chance, I go for a long walk in the bush.

RACP: Thank you, Dr Brebner, for your time.

Dr Brebner: My pleasure