Mental Health and the Medical Journey


Interview with UQMS from June 2018. This is the pre-publication unedited version.

Could you tell us a bit about the experiences in your medical journey?

I completed my MBBS through The University of Melbourne as a postgraduate student. I did my residency all over Victoria. I accentuated these experiences with Medical trips to Fiji and West Timor to add a little flavour of Global Medicine. I got myself a PostGrad Diploma of Surgical Anatomy and a Master of Public Health and Tropical Medicine during residency. I entered General Surgery SET training and then Otolaryngology Head & Neck Surgery Training Program. I did one year of Fellowship in Canada in Head & Neck Surgery and then two more fellowships in Paediatric Airway and Head & Neck Surgery in Brisbane and Auckland. It has only taken me a short 13 years from graduating Med School to working as a Consultant Surgeon. I guess I’m a slow learner. It has been arduous and fun. My wife, an Infectious Diseases Physician, thinks I’m crazy.

The very successful launch of #CrazySocks4Docs in July last year really transformed the climate of conversation on mental health between health professionals nationwide. Now that a real conversation has sparked, what other improvements would you like to see from this year’s campaign? What worked well last year?

It has indeed been encouraging to see the effect of the Mental Health Awareness campaign. I am delighted to see and hear that this issue is often at the forefront of our minds and more importantly in the public arena through several news, radiology and television subject. This is good. The more we talk about Mental Health among clinicians, the more we dispel they dark myths around it and the more we can normalise the experience and challenges. The results of awareness campaigns are often hard to measure in numbers or dollar value. However we are confident that Colleges, Medical Institutions and Medical Schools are working through this issue as seen through the evidence that it is a topic included in Grand Rounds, conferences, Plenary Sessions, and Hospital or College Newsletters. The next step is to look at practical solutions that will look different in different contexts. There are no single simple solutions to mental health care in the health care industry. It requires legal, state-wide, institutional, departmental, even practical roster solutions if we wanted to be serious about managing this challenge.

Can you tell us more about your planning and campaign with Dr Geoff Toogood, and what initially inspired the two of you?

You better speak to Dr Toogood directly if you wanted to get the story from his end. It was an organic spontaneous awareness campaign. This came at a time when I was dealing with my own occupational burnout. I had always worn crazy socks from even way before it was cool. I supported the idea behind the campaign and all I did was leverage it to the wider community through social networks. At the end of the day it was for Dr Toogood to inspire discussion around this issue. There has been many people who have been working hard in this arena for many years (psychiatrists, psychologists, counsellors, etc). He used a simple object as a point of discussion to leverage the message to the general public.

Despite the positive conversations surrounding mental health happening internationally, the fear of judgment is still a prohibitive factor to individuals sharing their personal experiences. How can we create an environment in which we are more comfortable talking openly?

In essence, the two major limiting factors are regulatory (Mandatory Reporting rules in some states) and cultural (“doctors are not meant to be weak”). The good news is that the regulatory side is being worked through at the moment because there is a lot of confusion around that. We need to accept that a doctor seeking medical treatment for mental health can be a safe and effective doctor just like any doctor with cardiac or neurological condition. A well-treated mental health illness is a stable condition. Having a mandatory reporting rule may become a hindrance to other doctor seeking help. This hindrance places the doctor and their patient at risk. It is the undiagnosed untreated illness we should worry about, not the ones who present to their GP and mental health professional. Of course, if a Mental Health Professional is deemed unsafe, they can be reported, but to have a blanket rule that is poorly interpreted is not necessarily helpful. The second issue, cultural, is a little more insidious and hard to change. The medical community has an unhealthy expectation of perfectionistic heroism. It’s ingrained in our selection process and training. We pick the best students, compete them against each other in med school, put them through horrendous jobs that mess with their body clock and social life, expect them to never fall sick and always be perfect. Very few remembers the 99 great things you do, but you get crucified for the one time you drop the ball. There are no back ups on the system as well such that when we have to take a day off sick, other docs have to cover our jobs and therefore we feel bad. Cultural change takes time. Awareness, acceptance and admission to the problem is the first step. Leadership is the biggest catalyst to this process. We will get there. We will change because I have seen the process of change occurring in so many places. But it will take time. You can’t change culture overnight.

There is a paradox within healthcare that doctors and medical students often ignore their own health and wellbeing. Is there any way to recognise burn-out before it becomes a real problem?

Absolutely. Just as much as we need to look after our physical and cognitive health, it is imperative that we learn to look after our mental and social health. Let me also point out that mental illness such as depression and workplace illness such as burnout are two different conditions requiring different treatments. They’re obviously related, but the way we manage them differ. Burnout is a state of chronic occupational stress characterised by emotional exhaustion, cynicism and lack of effectiveness. Depression on the other hand is a DSM-V ICD-10 diagnostic category of mental health condition. Diagnosing, investigating and managing burnout is not the same as managing depression. With regards to depression, we need to encourage our colleagues and ourselves to seek assistance from a Mental Health Professional and we need to remove barriers to this. With regards to burnout, we need to consider workplace factors that contribute to the condition, such as roster safety, leadership initiatives, support systems, positive culture and the like. We must look beyond the individual and pay careful attention to the workplace environment as well. It is not that difficult to spot a colleague who is emotionally exhausted (angry, irritable, sad, etc), highly cynical (sarcasm, repeated complaints, etc.) or with poor effectiveness (uncompleted tasks, delayed jobs, etc.). What is harder is knowing what to do about it.

We dedicate so much time towards learning how to diagnose and treat our patients, how common is it that we miss the signs displayed by our struggling colleagues? What can we do now as students to be better doctors for our friends and family?

We are trained to help patients. Medical school curriculum does not train us to help our colleagues. In fact, all that I was ever taught was to report, not help, a struggling colleague. We need to change this. Firstly I would encourage each student to strengthen their social network within and outside of medicine. Having a strong social network will keep you in a safe place when things at work is difficult. You need medical friends who understand the daily struggles you have and you need non-medical friends to give you a greater perspective on life. Secondly, in the same way you commit yourself to understanding how to manage a cardiorespiratory arrest, commit yourself to understanding how to assist your colleagues. Every institution, colleges and state has some sort of a Guide to Clinician Wellbeing. Read them. There are many resources available locally, on the internet, on paper publication, and phone lines for assistance. There are many lectures, talks and other sessions in conferences around this matter. Educate yourself and you will have the tools to be of great assistance to your colleagues. You may just save a life.

There are a lot of medical students who are passionate about advocacy but feel that they do not have a tangible way to make a real positive change. What are your tips on overcoming this barrier?

This is why I believe that the future of medicine is bright. I see a generation like yours rising up within the ranks of medicine. A generation that is committed to a greater cause, passionate about being global citizens and has a strong sense of social justice. In addition, you are also powerfully connected. The old cliché does apply: start local, go global. You are more powerful and influential than you think you are. You are already well educated and well trained. Go find a local need and fight for it through simple means such as media communication. Advocate for the patient in front of you. The car park is too expensive for patients? Write a note to the private car park company as a medical student group. You want to see more female role models in Medical Education? Write to the Dean and ask to have more female lecturers and tutors. Research funding is poor? Activate your social media network and crowdfund for a research focus. There are so many simple little ways that you can do locally. The problem is that sometimes we want to see big results quickly. Advocacy takes time. Small snowflakes over time turn into avalanches. Pay attention to and change the small things. The bigger ones will follow.

What is your definition of advocacy? How can we all become advocates for better outcomes?

Advocacy is helping others lead better lives. Focus on others: your colleagues, your patients, your community, your institution. Advocacy ends when we start thinking “What’s in it for me?” True advocacy means that we fight for another person. Sometimes, there’s just nothing in it for me. If you’re lucky enough to be a student and a doctor, by societal perspective, you are lucky enough to do something for others without any immediate benefit. The legendary advocates are almost always those who sacrifice personal comforts for the sake of another person or community.

How do you juggle life as an ENT surgeon, dad, speaker, blogger, and advocate? What do you do to look after yourself?

I do juggling terribly. I’m still learning. I’ve never done any or all of these before. As a doctor, our career trajectory is full of detours. Just embrace it. I am lucky to have an awesome family who are made up of my best supporters. To look after myself I do regular quiet times to read and think, personal journaling and weekly social gatherings. I balance my need for social connection with private moments. I need regular times alone.

Do you have any advice for students who aspire a future career in surgery?

It’s the toughest yet most fulfilling career ever. Sorry I’m biased. I still often pinch myself. I can’t believe that I get to do some crazy things on a daily basis that very few people ever get to do. First advice is this: every specialty in Medicine and Surgery is noble and fascinating. There is no one specialty better than another. You simply need to find some specialties that suit your interests, curiosities and personality make up. Find a few, and look into them. Direct your studies, research, electives into some of them and figure out if they suit you. If you’re good, whatever specialty you end up doing, you’ll make it awesome. Secondly, don’t be fooled by media portrayals of specialties. Emergency Medicine is not always like ER. Surgeons are not all like those on Grey’s Anatomy, and Physicians don’t do what Dr House does. What you think happens in a particular specialty is not what really happens. See what the registrars and consultants do on a day to day basis. Appreciate the mundane in those specialties. There are a lot of mundane routine work in every specialty. Can you handle them? Thirdly, look at the people in those specialties. They’re going to be your workmates for life. You better like them. I was initially interested in another surgical specialty, but I didn’t like the community attitude in that specialty. I chose ENT because of the work and the people. I not only like ENT Surgery, I like ENT Surgeons.

The road to medical school involves getting through years of academic competition. How important is it to understand that medicine ultimately isn’t a race, and that our future success cannot be solely quantified by grades?

If this was a race, I’m definitely one of the biggest losers. I’ve lost count of the number of times I didn’t get my first preference, had research rejections, failed exams, missed out on surgical selection, etc. Competing with others and with yourself destroys the joy of Medicine and Surgery. There is no need for competition because it is not. You do have to get the grades and make the cut because we have to be excellent at what we do. No questions. We study and work hard not to pass exams but for that day when you are the only person standing between a patient and their disease. We must strive for excellence. But the measure of excellence is not solely in the Academic grades realm. Grades are not the full measure of a doctor. Patients won’t know that you got an A for first year Biochemistry on the Kreb’s cycle, but patients do care that you are competent, compassionate and collaborative. Gain competence through collaboration, not competition. Gain compassion through your own good self-care. You can’t give out of an emptiness. The biggest reward in Medicine is not grades or academic awards. The biggest reward in Medicine is grateful patients.