MIC CAVAZZINI: Welcome to Pomegranate Health, a podcast about the culture of medicine. I’m Mic Cavazzini, for the Royal Australasian College of Physicians.
Not a day goes by that there isn’t a headline about the overstretched health service and the struggling professionals within it. In May, RACP past President John Wilson made a searing critique of the state of health system as he quit his job at the Alfred Hospital after 30 years of service. He told journalists of the Age newspaper that he was leaving “because I cannot keep working in a system where we are not able to deliver top-quality care with limited resources when staff are being burnt out to the point of exhaustion.”
It isn’t COVID that has created this situation. The pandemic was just the straw that broke the camel’s back and Professor Wilson said that we’d continue to see an exodus of doctors, nurses and paramedics until something was done to ease the relentless pressure they were facing. In another opinion piece for the Guardian, John Wilson observed that in a burnt-out health workforce, empathy was in short supply, bullying was common and that a leading cause was the breakdown of respect between hospital administrators and clinical leaders. Professor Wilson warned that Victoria Health was on the verge of a reckoning like the infamous mid-Staffordshire scandal. An inquiry into that British hospital Trust a decade ago found that unsafe care had been linked to a toxic workplace culture.
Professor Wilson’s claims are alarming and expansive, and I’ll follow them up in another podcast. But today I want to share some positive stories about dealing with this stressful work environment. Not just surviving in it, but redefining your role in medicine on your own terms. The presentations you’ll hear were recorded at the recent RACP Congress in May. The adversities described by each of the presenters were all different and not tied to the workplace alone. Associate Professor Michelle Telfer was hounded for two years by the conservative press over her work with young people struggling with their gender identity. Pain specialist Olivia Ong was driven by an unhealthy professional identity until a traumatic spinal injury forced her to dramatically reconsider the meaning of care.
But first we’ll hear from Eric Levi, a surgeon at Royal Children's and St Vincent's Hospitals in Melbourne. He’s a natural educator, and you can find a trove of insights at his blog. Eric Levi defines burnout not as a mental health condition but as an occupational disorder with clear solutions requiring a brave leadership.
ERIC LEVI: Wominjeka—welcome. And to our friends and colleagues across the ditch, Kia ora, tena koutou, tena koutou, tena koutou, tena koutou katoa. We heard stories about systemic difficulties and systemic challenges in our workplaces and the pandemic obviously, has driven this right into our conscious minds, for sure. The words get muddled up sometimes. Stress is what we experience when we face typical day to day challenges. There's stress, there's distress. Stress is a normal part of life, a normal part of exams. Then there is compassion fatigue, which is what we experienced when we've been giving out again, and again and again and again. And many of us here work in the “over and above kind of specialties”; you just go the extra mile for your patients, for your trainees, for your team.
Moral injury is when you want to do something, but the resources doesn't allow you to do it. When a surgeon cancels a case because there's not enough nurses on the ward to look after the patients, that's moral injury for us every time we cancel that case, and you know that in your own specialties. And burnout is this big thing that we talk about again and again and it has three parts to that. It's an occupational disorder, it is not mental health or mental illness. It is an occupational disorder. And mental illness or mental disorder is a whole different category. It's a DSM-5, ICD 10 categorization and you know this better than I do.
As a surgeon, I can only remember three things. So there's only three things that I want to share with you, and this is the first one; that mental illness is not burnout, burnout is not mental illness, there are two different things. There's no amount of antidepressant that can cure a toxic workplace. There is no amount of self-resilience that can cure an abusive system. Burnout comes from the system or the workplaces—it’s an occupational disease.
579 internal medicine physicians was polled. 38% burnout. What about the story in Australia? This is my trainees. Sixty trainees in Australia—70% of the met the criteria for burnout. What are the predictors? Separation from family; difficulty with work and non-work balance; feeling uncomfortable with approaching a supervisor. And what if we ask the physician trainees? Do you really want to know if you're a physician trainee here, what it looks like? 53% meet the criteria for depression. These are your trainees. Physician trainees. 51% meet the criteria for high stress; 46% anxiety. Only half of your trainees actually get enough exercise, and a few of them don't even get more than six hours of sleep a night.
And who are the groups at risk? Of course, we know this. Females, junior trainees are at high risk. Mental health is a different side of the coin that is associated, but not causation. Many of us in this room may have been in that one in four who have had thoughts of suicide. And studies have shown that during the pandemic, perhaps about one in two of us have had thoughts of suicide and giving up.
And this is the second part that I want to shift this discussion to. What are the effects of burnout, we know about the personal effects. But what about what happens at work? Physician burnout has been strongly associated with medical errors. 6500 physicians and we talk about physicians in a North American term here, including radiologists, pathologists, emergency department doctors. 54%, burnout—again, very similar—30% fatigue; 6% suicidal ideation.
But this is the key statistic here. One in 10 of them actually thinks that they've made a major medical error. And so when they do a multivariate analysis, the people who are physicians who are burnt out are more likely to have reported medical errors. And this is very similar data with surgeons, in particular. 7900 surgeons; again, one in 10 have reported a kind of an error, a surgical error in the past three months. And when they correlate with their level of burnout, these surgeons are two or three times more likely to make an error. And that's a pretty powerful, powerful statement.
And all this time we've been pushing burnout to the domain of the individual, and our administrators will never listen to us, will always push the solution to the individuals. It's only when we say that burnout is a danger to the hospital and the patients; it’s a reputational issue; it's a legal potential risk; that's only when we get them hearing; that's only when we get them listening to us to actually say that burnout is an occupational risk and challenge, not a personal solution.
The administrators think it's a doctors’ problem. The doctors think it's a junior doctors’ problem. The junior doctors think it's a College problem. The College thinks is the jurisdiction of the health ministers. Whose problem is it? Well, we're here we're part of the community. The fact that you're here in this meeting means that you're holding some sort of a senior position. You're the one carrying the burden of a lot of your trainees registrar's, your patient and your team.
And there's a lot of things that has been proven to be helpful in dealing with burnout. There's a whole long list. But if I could just shift that focus and help you think that if burnout is an occupational problem and syndrome, the aetiology is occupational, the complications are occupational, therefore the solution has to be occupationally-focused as well.
What are the potential interventions that we can do when we walk home to our departments next week or tonight? At the departmental level, again, studies have shown that the quality and the safety of the leader in the unit has got a huge effect on the burnout level of the staff. Based on certain leadership factors, if you increase that leadership safety and quality by one point the staff burnout level drops down. I wonder if you’re a department head here, would you be willing to actually check the amount of burnout in your department and see whether or not that could be a measure of how effective you are as a leader? It's a pretty scary thought, if we were to ask our staff member how we're doing as a leader. And when I say leader, it could also mean supervisor of training, it could also mean represented representative in community in your in your Colleges. Positions of influence matter.
And do you have to do a lot? Do you have to go through you know training? When we bring this up with administrators, the administrators often want to come up with a solution that involves yoga at 10 in the morning when we're all in clinical operating, or some sort of five by 90 minute sessions after hours, which will burn us out even more. So that's not the solution. As it turns out, when you qualitatively ask junior stuff what matters most to them, it's just the sense that they're part of the team. They just want to be asked, “How you're doing?”, “How can we support you?” and, “How can we help you?” And I think you do this a lot better than some of us in other specialties. So kudos to you.
What about the regional, national and the College level? And you're meeting here, you're having this discussion as a group as a community, because you've got great plans and programs. The College of Physicians have got a chapter on wellbeing, the College of Surgeons have that. And even as a group, we've actually met, and I'm part of this group as well as created that Wellbeing Charter for Doctors. But just remember that all these things end up being yet another policy document that sits somewhere in the aether of the internet, or in the filing cabinet somewhere. And unless we as leaders embody some of these principles, and our trainees see this, nothing's going to change. This is yet another wonderful-sounding document.
If I could just summarize and I've only got 30 seconds left, what is a clinician looking for in their work? These are just the three things; Sense of autonomy, a sense of belonging as part of a team, and sense of contribution, that significance part of your role, that you have something to contribute. How much autonomy? How much contribution? Interestingly, this particular study just shows that if you spend 20% of your time doing the work that you find valuable in in that you find passionate about—and to you could be academic research, or departmental leadership or teaching education, mentoring, or operating—you will have a high job satisfaction—it doesn't have to be 100% autonomy.
In conclusion, burnout is an occupational disease, and we have to shift that discussion to say that physician wellbeing is a workplace productivity and patient safety issue, therefore, the intervention has to be at the workplace. Thank you.
MIC CAVAZZINI: The next speaker you’ll hear from is Michelle Telfer from Royal Children’s Hospital Melbourne. She is Director of both the Adolescent Medicine department and the RCH Gender Service. Dr Telfer provides care to trans and gender-diverse children and adolescents, many of whom benefit from counselling alone. But some feel so distressed by the incongruence of their gender identity and their bodies, that they seek to delay their progress through puberty or to transition using gender-affirming hormone treatment. These profound decisions carry medical, psychological and ethical weight and are highly regulated. They are never taken lightly by patients, their families, or their doctors but gender transition is a polemic issue for a segment of society. Michelle Telfer spoke of the period when these polemics boiled over in the press and into her daily life.
MICHELLE TELFER: People say that whatever doesn't kill you makes you stronger. I disagree. Whatever doesn't kill you, gives you trauma symptoms. What makes you stronger is how you find a way to pick yourself up off the ground, walk towards a place where you can live with yourself and your circumstances, and hopefully, over time, find a way to thrive again.
On the 9th of August 2019, I became a target of the Australian newspaper. During the first year of this two year campaign, 45 articles, including three editorials were published with 80 direct references to my name, Telfer, and 282 direct references to my work, and that of my team at the Royal Children's Hospital Gender Service here in Melbourne. The publications were consistently of a highly critical nature, and were repetitious in their false inaccurate, unfair and unbalanced information that questioned my credibility, my integrity, and my honesty. I was portrayed as someone who was harming children. The personalization of this issue was taken to an extreme with a negative description of the RCH gender service as “the Telfer clinic”.
In the years prior to this, I'd had much success. Since 2012, I've been the director of Australia's largest clinical and academic multidisciplinary gender service for children and adolescents. Last year, we received 821 new referrals. My advocacy work had been pivotal in changing the law in Australia to improve access to hormone treatment for trans adolescents, a situation reported by the Australian Government in the joint 5th and 6th report to the United Nations. Under the Convention of the Rights of the Child. I had led the creation of the inaugural Australian standards of care and treatment guidelines, which was praised in an editorial in the Lancet in 2018, for its evidence-informed, gender-affirming approach to care.
Actually, in the days prior to the first article being published by the Australian newspaper, The Lancet Child and Adolescent Health journal published a personal profile celebrating my international influence in the field. No positive reference was ever made to any of these achievements by the Australian newspaper. In fact, what was published was in stark contrast to this. It was not news, it was disinformation. Its effect was to deliberately create fear and anxiety, to exacerbate the stigma, discrimination and prejudice that exists against all trans children and young people in our society. It attempted to destroy my professional reputation, and to destabilize the growing network of clinicians and researchers across the country who work to improve the health and wellbeing of this extraordinarily vulnerable group. It undermined the trust that patients and families had in their treating clinicians and caused concern and trepidation for families who are yet to seek professional support and medical care. It also sought to influence political opinion and decision-making at the very highest levels of government. The Australian newspaper made public requests to the Federal Minister for Health, Greg Hunt, to conduct a national inquiry into our work.
At a personal level, it's really hard to describe how it feels to wake up in the morning and find yourself the subject of an article in a national newspaper with the headline, “Gender reassignment? They’re castrating children. Medicalization of gender is dividing our society and abusing our defenceless young”. I'd seen the nastiness of the conservative press in the US and the UK, but I actually never imagined that I would be the prime target here in Australia. Perhaps I was just naive. I was not prominent on social media, nor in the mainstream media at that time. I was a paediatrician, leading a large multidisciplinary team, providing evidence-informed health care for trans young people. I was just doing my job.
Minister Hunt wisely referred the question of whether a national inquiry was needed to the RACP. The RACP undertook a review of the evidence and consultation and concluded that a national inquiry would not be helpful, as it wouldn't increase the scientific evidence that exists, and actually suggested that gender-affirming care as practiced by the RCH, and many of the gender services across Australia, should actually be expanded so that all trans children and adolescents had better access to this care across the country.
Nine months after the commencement of this campaign by the Australian, the Federal government, the Victorian Government, and the RACP had all expressed their public support. And yet the negative articles about me just kept coming. So did the resultant hate mail, the phone messages all to my office at the RCH. It was relentless. I blocked everything and everyone I could. It felt like harassment, and it felt like abuse.
Not only was it distressing for me and my family, my team and the RCH. The impact on our patients and families was enormous. I cannot overstate this as they, in essence, were the real targets here. Their right to exist as trans people was being publicly questioned and largely dismissed. My role in providing care for them became really complex. Many parents and their children came to appointments and asked how I was. They asked about the impact on me, the potential impact on the RCH gender service, and also the medical infrastructure that they relied on to get access to the care they needed. Me reassuring and supporting these kids and families whilst also becoming part of this traumatized community created a sense of vulnerability I'd never experienced before.
After a year of being encouraged to stay silent and not to fuel the fire, I couldn't do it anymore. I was waking every morning with anxiety-induced chest pain and a sense of powerlessness, which was overwhelming for me. I was overworked running my Adolescent Medicine department, of whom I have 60 staff to manage during a COVID pandemic and I could not see a way out. I sought legal advice, which confirmed my suspicions that taking on the Murdoch press in defamation proceedings was going to potentially ruin my family, as well as my soul. What is one to do?
My strength has always been in my persistence, and my ability to stay calm under pressure. I really needed to fight back. I took a week of leave from my job. And I read through absolutely everything that had been written about me since that first day in August 2019 a year earlier. Analyzing each published piece, I compared it in relation to the Australian Press Council guidelines. Much of it I actually hadn't read before in any detail because I found it too distressing but by day three of this process I'd stopped experiencing psychological response to seeing the words in print. By day seven, I had a 42 page complaint to submit to the Australian Press Council. I did some positive media with the Age, The Sydney Morning Herald and the ABC's Australian story.
I made a submission to the federal Senate inquiry into media diversity, and in their report tabled in Parliament, my situation was outlined as a case study example of how regulation of our media industry in Australia is inadequate. A person wrote a comment on Twitter in relationship to the detail of my Senate submission, which was available publicly where they said, “the Professor kept her receipts.” I felt like I was getting back on track, standing up for myself. Being proactive felt good, even if nothing else changed.
It would be another year, and many more articles before the Press Council would find the Australian guilty of breaching three major principles of the Press guidelines. The 45 articles collectively were found to be inaccurate, to lack fairness and balance and to cause unnecessary distress to both me and the trans community. Interestingly, on the same day that the Australian newspaper was mandated to publish the APC adjudication, they also published an editorial about me just a few pages on where they painted me as an emotional female, having hurt feelings and lacking any credibility. They were as the ABC Media Watch pointed out, “shameless”.
Despite this final outburst, it was from the Murdoch media, the articles naming me stopped, and the journalist responsible for almost all of them apparently doesn't work there anymore. This could look like a win. But it does not feel like a triumph in any way. The harm done to all of us, most importantly, the harm done to trans kids and their families remains. You just have to look at the media during this Federal election campaign to see how these most vulnerable kids are a battleground for political gain. And there are many of us who get caught in a crossfire. I feel very connected to this community. And I have been full heartedly embraced and supported by them as an ally. I continue to dedicate my work to making sure I'm doing their very best to help them thrive. That's what keeps me going. That's what leaves me most proud, most purposeful, and on the way back to being able to thrive myself. Thank you.
MIC CAVAZZINI: Michelle Telfer’s ordeal is extreme, but by no means unique and it reveals how the medical profession more than most can consume one’s personal life. It’s not within the scope of this podcast to present the other side of this contest in any great detail, and the national newspaper has a big enough platform in its own right. But it is worth taking a moment to look at the judgement of the Australian Press Council to understand how far apart the world of mass media is from academic medicine.
Several of Michelle Telfer’s complaints were upheld by the APC. That the Australian newspaper hadn’t reported on the 20 year evidence base supporting gender-affirming therapy or rulings of the Family court approving of this approach. That the newspaper had not accurately portrayed the position of the RANZ College of Psychiatry on the Australian treatment guidelines. And that that the newspaper had presented several medics and psychologists critical of gender-affirming care as experts without explaining that they didn’t practice in the area of transgender healthcare.
In this the Press Council stated that “the publication failed to take reasonable steps to ensure fairness and balance” but also that “there is no requirement for the publication to rely only on such experts.” The Council did not comment on Dr Telfer’s concern that the religious and political affiliations of the most vocal of the critics had also been omitted by the newspaper.
The APC accepted the newspaper’s defence that they had approached Michelle Telfer for comment and offered her the space for an opinion piece. Speaking from my experience both in research and in journalism I can sympathise with her decision not to do so. Having already subjected her work to peer review by experts in the field, to then have it labeled as “opinion” would have only give the opposing viewpoint equal standing, regardless of how well-supported it was.
At the big picture level, the Press Council ruled that there was “undoubted” public interest in a journalistic review of this subject even with its potential to cause distress to the community in question. “However, the public interest did not justify the extent of references to the complainant in so many of the articles or implying that the healthcare practised at the RCH Gender Service is out of step with mainstream medical opinion.”
I’d agree that there is certainly a place for public interest journalism about medicine. The reporting on the irresponsible use of oxycodone or vaginal mesh implants are two dramatic examples that have led to class actions against the companies promoting those products. By contrast, it’s hard to see how the work of the RCH Gender Service warranted attention so disproportionate to the number of clients being treated, a tiny fraction of whom might go on to express regret as with any elective intervention.
The Australian’s defensive editorial on the Press Council ruling gives a hint as to the ideological agenda that may have driven the newspaper’s febrile reporting. The editors wrote, “It is possible to conclude that the complaint made to the APC is another example of the cancel culture tactics used to stifle debate… It can be argued the APC has been swayed unduly by a concerted campaign by activists.”
The journalist leading this crusade had made similar comments a few months prior in an interview with Quillette, a platform where "free thought lives". In fact, Bernard Lane, went so far as to say that the medical establishment too had been taken hostage by trans activists. He claimed to be providing “balance” to the scientific discussion and protecting vulnerable children. Lane had done plenty of reading, but seemed to think that Michelle Telfer and colleagues had not. He implied that they were oblivious to the limitations of clinical research, the complex ethics around medical consent or the volumes written about the psychosocial determinants of gender. Though no longer at the Australian newspaper, Bernard Lane doggedly continues to comment on the apparent folly of gender fluidity and runs a watchdog website dedicated to gender clinic practices around the world.
My point is not to dismiss opinions that are sceptical of medical consensus but just to try and understand the motivation behind them. Often there are elements of truth or good intention behind such campaigns, but it becomes hard to empathise when the attacks are so personal. To go back to the pandemic, resistance to vaccination was another example where medical practitioners were in the firing line of fiercely held beliefs. It’s not a doctor’s responsibility to take on these assaults single-handedly. Consult your colleagues and make sure your wellbeing is a top priority.
Let’s go now to a very different struggle against daunting odds. Dr Olivia Ong is today an established pain and rehabilitation physician, a motivational speaker and an author. But fourteen years ago she was a workaholic junior doctor, until her training was derailed by a devastating accident.
OLIVIA ONG: On one fine spring day in 2008, my life changed forever. I remember this day very clearly 10th of September 2008. I just had an amazing lunch with a good friend of mine. And I was walking along the hospital carpark and I replayed the conversations I had with her. It brought a smile to my face. In fact, I had a spring to my step, I skipped and walked on the way to the hospital. And suddenly I was hit by a car high speed. My body was flung into the air. And as I hovered like a slow motion movie, a few thoughts ran through my head.
You see, a few years earlier in my late 20s, I had ticked all the success boxes. I was working as a resident doctor in a reputable hospital, happily married, had my own house and car and I had a great network of friends. In fact, life was really great. But in reality, I wasn't fulfilled. I lacked self-worth. Why do so many people who seemingly have it all lack self-worth? Being a perfectionist, I used to beat myself up for making the tiniest of mistakes, and didn't listen to my own needs when work got busy. In fact, I even wished I had a catheter so I wouldn't have to start working to pee. How crazy is that, right?
As a doctor, I was programmed as a Lone Ranger. I did not seek help because that meant I was weak, dare I say not capable. My Lone Ranger programming made me feel isolated, disconnected and helpless. Which is exactly how I felt flying through the air. As I was struck by an old Toyota Camry flying at 60 kilometres per hour. At least I could chosen a Mercedes, right? I landed with an earth-shattering thud. I had a spinal cord injury. I lost the ability to walk.
Being a patient on the other side of the healthcare system was certainly an eye-opener, and very challenging days for me. Funnily enough, this time around, I really did have a catheter. I felt like a pin cushion as well with drips on my arms and a nasogastric up my nose. I had never felt so vulnerable, so alone in the trauma ward at the Alfred Hospital. It turns out I had an L1-L2dislocation, a smashed L2 vertebra and cauda equina syndrome. And I had to have emergency spinal surgery that same day.
After my surgery, I used all of my willpower to move my legs, day-in day-out but I couldn't. I felt defeated. So broken, so helpless. Lying alone in the hospital bed at the Alfred Hospital. I felt such intense grief and loss following my injury. I was really angry at the driver who hit me. He was an elderly gentleman with severe dementia who shouldn't be on the road. He pressed the accelerator itself the brake and I was at the wrong place and wrong time. Thoughts went through my head as I was lying there by myself. Will I be able to walk again? Will I ever be a doctor? That was my identity, that was all I knew. I'm such a burden to my husband. Will he leave me? Will I ever have kids?
If you have suffered a loss or been through a traumatic accident you know how it feels like to blame yourself for your accident. For everyone to look at you with pity, feel sorry for you. It makes you feel sorry for yourself. My self-worth which was already low at that point plummeted to the ground. I so badly needed to walk again. Not because I wanted to be mobile. But because I wanted to have my identity back, even an identity which lacks self-worth.
One day I heard about Project Walk a spinal cord injury recovery centre in San Diego United States. I listened to my intuition pack my bags, took two years off my rehab training as a registrar and off I went to the United States and my husband. At first I thought the state of the art technology was what was going to save and help me. But I realized that my three years at Project walk doing intensive rehab taught me a far more important life lesson. Self-compassion.
You see my experience to learn to walk again was the exact opposite of my life as a junior doctor. Instead of being on autopilot I had to be mindful of each step I took. In fact, I had to relearn to walk again, like a baby, learning to crawl learning to stand going to take small steps and big steps and more steps around the gym. Instead of being a Lone Ranger struggling to seek help, I connected with fellow spinal cord injury survivors, bound together by our common humanity and our common suffering being spinal cord injury. These are my friends on wheels, whom I still keep in contact up to this day.
Most important of all, instead of being a perfectionist, beating myself up for every mistake I made, I learned to accept myself for who I was. Mindfulness, common humanity, and self-acceptance. These are the three pillars of self-compassion. And these were the things that gave me self-worth. Not walking again and definitely not the initial success I had earlier. After three years spending five hours every day doing physical therapy at Project Walk, I learned to walk again. And I was over the moon. At that point, when I finished up over at Project Walk in 2013, I went back to my job as a rehab registrar in Australia, happy, enthusiastic and ready to tackle new challenges.
Research indicates that self-compassion leads to increased productivity. It allows you to be calm in the face of challenges and adversity. And how does it do that it activates a soothing system which allows you to reduce stress. And that leads to greater feelings of wellbeing. Slowly but surely, my self-worth started coming back. I went on to pass my Fellowship exams in rehabilitation medicine 2014. And I was in the same building eight years ago, getting my Fellowship Cert and I went on to pass my fellowship exams in faculty of pain medicine, 2017. Here are my friends and I, all Pain fellows, slightly a little bit tipsy after we all found out, we passed the exams, it was a hard year for all of us.
And then I went on to have two beautiful children whom I adore. I built a beautiful life from something that was traumatic and sad. I became a formidable force in the lives of my family and friends, also became more influential around my medical colleagues, who were initially very sceptical and eventually learned to respect me. And most important of all, I learned to respect myself. I rebuilt my identity to have self-worth through self-compassion.
You might be thinking, I have got my life altogether. But I didn't. I was severely exhausted. I had insomnia. And I was sarcastic and cynical, I was a horrible person to be with. And at the time—my first year as a pain specialist—I was juggling motherhood with a three year old and a disability on top of that. I wasn't looking after myself, I was withdrawing and disconnecting for people around me. And turns out it was a matter of time before I fell facedown with burnout. And this time, it wasn't because of my legs.
It took me a while to recover from burnout. And let's say the tools I used were unconventional. I got some coaches to help me work through some mindset issues and limiting beliefs. I got some mindfulness and self-compassion teachers to teach me certain tools. And in the end I recovered from burnout. And right now, three years on, I've got more energy back, I'm more present with my kids. And this is me today practicing, mentoring and coaching radical resilience, which is compassionate and resilient leadership in a modern society or economy. And the reason why I set up my coaching and mentoring business was two things that broke my heart; physician burnout and physician suicide. Physician burnout is as an all-time high; 70%, in fact, post-COVID. This was my inspiration behind the book that I wrote, called “the Heart-Centeredness of Medicine”, which I published last year on RUOK day.
And I've got my life purpose back, which is essentially this beautiful pottery, Kintsugi; ancient Japanese art, which uses golden resin to build up old broken pottery back together again. And when the light shines through the golden resin, the object is as new and more stunning than ever. We honour our cracks. We honour our struggles. My message for all of you is to live your life with self-compassion and radical resilience. Thank you for listening to my story.
MIC CAVAZZINI: In the next episode we’re going to hear from a couple of career coaches about how to shift some of those perceptions. One of them is Sarah Dalton who coaches on top of her day job as a paediatric emergency physician. Her dedication to professionalism is apparent from her previous roles on the RACP Board, as past President of the Paediatric and Child Health Division and in countless working groups.
Sarah Dalton told the Congress that many of the doctors who come to her for coaching have never shared their struggles with anyone—they all believe that their colleagues must be coping far better than they are, but only because they’ve been too ashamed to discuss this openly. Dr Dalton chaired a Q&A session between the presenters you’ve heard already, and I’ll just share a few of their final thoughts.
SARAH DALTON: To kick off the panel discussion though, I wanted to ask them all to give themselves some advice. Each of our panel members have been kind enough to share with us a photograph from when they were younger. And my question to each of them is at your graduation from medical school, when you had spent so long learning to how to care for other people, if you could go back now, and give yourself some advice about how to care for yourself as a doctor. What would it be? So I might start with you, Eric, and then move along. If you could go back to your medical student self, what advice would you give yourself to be?
ERIC LEVI: I'd say buy Bitcoin. I'll be really well by now if I had Bitcoin. Look, it's amazing, isn't it, I mean, who would have thought that we're where we are talking about this. I think the only advice that I would say is, “Medicine is not everything.” You have to think there's an interesting study that says that people who believe that medicine is a calling for them, tend to have a slightly lesser rate of burnout, but to a certain degree. We all work between “medicine is a calling and “medicine is just a job”. And somewhere in there is the truth. And I think finding that balance will be the case I would be telling myself to, “Yes, it's great that you're doing what you're doing. But medicine is not everything.”
SARAH DALTON: Thank you so much. Olivia?
OLIVIA ONG: Yeah, I think what I'll tell my younger self will be to not try to get rid of imposter syndrome, and get good at it. Because I spent a long my whole life suffering from imposter syndrome, and I think that's a big cause of burnout in a lot of us doctors, so get good at it. When I was in my younger days, I've always felt like as inferior, I guess, to my peers which was made a lot worse after my injury, because I'm not an able-bodied doctor, like, I have to kind of prove myself all the time. But I think, to me impostor syndrome now means that I'm being challenged in a good way out of my comfort zone. I think, ultimately, just be you. And that's more than enough.
SARAH DALTON: Be you, that's more than enough. Thank you, Michelle, coming to you.
MICHELLE TELFER: When I think back to that day that I graduated—it’s a very long time ago now, I think I thought that I'd get to a stage where I know the answers, and that I would actually really feel comfortable that I knew what to do all the time. And I think what I would tell myself at that stage was, you never get to that point. And that's okay. That you're going to be faced with lots of decisions all the time, and you're not going to know what to do. And that is okay.
SARAH DALTON: I love the way that it's a good segue on from what your previous colleagues have said. I’d just like to round it out by coming back to the ABC framework—as I said, I'm an emergency doctor, so of course, that's the only thing I can remember—the Autonomy, Belonging and Contribution. And as each of you spoke, I actually think that's a beautiful summary. The bottom line is that the stories we've heard, where people are able to take some control, to be some kind of formidable force I think you said, Olivia, then you're going to be able to be in a position to thrive. You all spoke about belonging, and finding ways to belong or be part of a group is also really correlated with having that sense of purpose and thriving. I'll just pause for any final reflections, you'd like to add on that. And then I might go to some comments online. So go ahead, Eric.
ERIC LEVI: I just wanted to say that that's also something that we can give to our colleagues. What I mean by that is, if you're a department head or a supervisor of training or something like that, that's the ABC that your trainees need. And that's how we change culture of our department. ENT, we've got a small department in a current hospital. And we work hard at trying to give each other as much autonomy at choosing what they prefer—that's the sub specialty area. My wife is an ID physician, and last week, she had an ID community meeting and they invited the registrars, and the registrars were apparently shocked that they said, “Oh we've never been invited to any of these meetings before.” And it's just a dinner, but it matters to the culture of the place, as well, so that's the belonging part. It’s not just something that I think I want to get it my work, but it's something that I hope I want to give to my colleagues around me.
SARAH DALTON: Let me ask the rest of the panel when you think about that ABC, was there anything that comes to mind for you that gels with your particular stories?
OLIVIA ONG: I think for me for the belonging bit, I think just regularly checking in with your colleagues. Like, you know we have this, RUOK day, every year. Even just asking your colleagues, “Are you okay?” that will open up lots of conversations. And just looking out for each other. I think that's what we need, we need to do as a collective.
SARAH DALTON: I completely agree. And I think it's equally asking and listening. Michelle?
MICHELLE TELFER: And just to add in a similar vein that it's asking, it's listening, and it's role-modeling. As leaders and as head of department, I have shared my vulnerability, excruciatingly often in recent times, and today's obviously an example of that. But I feel that as a role-model for my department, it's okay to say, you know, “Things are difficult” and to show it in a way that's genuine and real.
I don't think I've ever felt more alone in my life than this time. And partly, the problem was that my friends and the colleagues I respect don't actually read the Australian newspaper. So they weren't necessarily aware of the number of articles. But of course, I was because I was the subject and everyone was telling me about it repeatedly. And also, when it first started to happen, because it seemingly came out of the blue for me, I felt that I was constantly being asked to explain and to reassure everyone else. So whether that was the hospital administration, the executive, the board, and the people that support our research. And there was just this constant need to reassure everyone I felt the pressure was very much sitting on my shoulders and my shoulders alone.
I know that's not the case, and I have fabulous colleagues—my team is amazing. And I also found supporters and allies within the system. And I'm just going to say that actually, Minister Foley, who's the Minister for Health, contacted me a number of times saying, you know, “Stay strong. And we're here for you. And this is really unfair.” And it was people like that, that made me feel that everything was going to be okay. And actually, it was really interesting to see that the people who were most there for us initially were our patients and families. Every time we'd go to clinic, I'd be reminded why I do this and why we need to keep going and keep fighting. And we go to, we'd get together and the parent support groups had sent in biscuits and fruit and sandwiches for team meeting. They did it a number of times, and it really did create a lovely community. And I've learned so much from it, actually, about the system about how to help others.
SARAH DALTON: Knowing you’re not alone. And it reminds me, you all know this metaphor of the swan with the legs down the bottom, and I used to talk a lot about, “you just have to be a swan and it's okay to have the legs going. But be a swan.” And I'm starting to say and find myself thinking about, “Actually, tell people about how much he likes paddling underneath.” Because otherwise people just see the swan and they go, “Oh, my goodness, you're amazing.” And they don't think they've got anything in common with you. And they're never going to be able to do what you do, because they don't see the legs paddling.
MIC CAVAZZINI: That was Sarah Dalton ending this episode of Pomegranate Health. Thanks also to Eric Levi, Michelle Telfer and Olivia Ong for allowing me to share their presentations with you. The views expressed in this podcast don’t necessarily represent those of the Royal Australasian College of Physicians.
If you’ve been feeling burnt out or just need someone to hear what you’re going through, there are several phone services providing support and confidentiality. The Doctor’s Health Advisory Service has different numbers in every jurisdiction of Australia and Aotearoa-NZ, which I’ve provided at the episode web page. The RACP partners with the 24 hour counsellors at Converge International whose number in Australia is 1300 687 327 and in New Zealand it’s 0800 666 367. But if you need crisis support right now, please call Lifeline. Their number in Australia is 13 11 14 and in Aotearoa-NZ it’s 0800 54 33 54.
There’s advice on how to counsel a colleague at racp.edu.au/fellows/wellbeing and also an eLearning course on caring for trainees under your supervision. For a full transcript of this episode embedded with links go to racp.edu.au/podcast. You’ll find musical credits there as well, and our contact address podcast @racp.edu.au. I’m Mic Cavazzini, and this podcast was recorded between the country of the Wurundjeri and Gadigal people. I pay my respects to storytellers past and present.