Day of the Girl

IMG_6476Day of the Girl. Sounds like a Terminator film title. ‘Day of the Girl: Rise of the Ovaries’.

Now, as you may have guessed, I spend quite a bit of my time thinking about, talking about and trying to improve gender equality in my little chunk of the world. I want the girls and women I come into contact with to see what they can do but also how it happens. I want to show them my flaws and mistakes so that they might learn from them. I want to create a collective voice that stands for all women reaching their goals, living a life where they can see their potential and fulfil their needs. I want women to have choice.

I grew up not really understanding that gender is a barrier. I never knew that because I was born a girl, that some people would see that as a weakness. I never understood that my intelligence would be both questioned and somehow demeaned if I was not pretty. And I definitely did not appreciate that even in a modern time, I would be required to work twice as hard as some of my male counterparts and I would be judged much more harshly for behaviours considered normal for boys but unbecoming of girls.

That being said, I am a middle class white woman. I am educated and I had a safe home with good role models in my life, some male and some female. I was not shot in the head for going to school, I was free to marry who I chose and I was free to do things in life that others might take for granted, like walking alone into the city. When I was born, my birth was celebrated not mourned. In fact, I was born when many girls are never given that chance when fetacide still occurs.

October 11 was declared by the UN to be International Day of the Girl Child in 2011. It aims to promote leadership and change so that girls around the world can lead full and safe lives. The very important message that we need to take from this day is that when we nurture and educate our girls, our whole communities improve. Health and welfare improves and violence abates.

I am very proud of what I have done in my life. Being a woman is a gift and I hope that I can use that to inspire and mentor those around me. It’s a tough gig sometimes but we are tough and resilient and resourceful. However, today, I want to take a moment to be thankful for the great opportunities I have had and mindful of those that others do not. It is so vital that for us girls and women who have privilege and a voice that we fight for girls everywhere.


Happy International Day of the Girl x

#ILookLikeASurgeon but that’s not all I am


Who Am I? – By Maximilian Toth

My fellow tweeting-surgeon-friend, ENT surgeon Dr Eric Levi, tweeted these two thought provoking messages today.

There were lots of replies. A few identified with the fact that medicine is not ‘just a job’ but a vocation, a calling and defines who we are. Some talked about the importance of having hobbies outside of medicine. Others talked about leaving medicine and how scary that can be. It seems that Dr Levi hit a sore spot. He certainly did for me.

I like to think that in my daily dealings with life’s big moments such as death, survival, fear, anger and caring for another human that I have learned what is really important in life. I have. I know that a wife desperately wants to see her husband get better after a long hospital stay. I know the raw emotion when a mother passes away. I know the sound of elation, relief and thankfulness when things have gone well. Yet, in putting that into practice, like many of my colleagues, I have fallen short of the mark.

Last year, I read the phenomenal book by neurosurgeon Dr Paul Kalanithi, When Breath Becomes Air. Paul was just about to complete his neurosurgical residency when at the young age of 35, he was diagnosed with metastatic lung cancer. Paul wrote the book as he battled this horrendous disease which ultimately took his life. I read it as a doctor who deal with lung cancer but also as a doctor who like Paul, had given up so much to pursue this ‘calling’.

As I read about Paul’s life and career, I found it echoed my own and that of many of my colleagues and friends. Upon diagnosis, he wanted to get back to work until the realisation dawned upon him that life was not the many hours spent in the operating theatres. While I was so sad that this young man lost his life to an aggressive cancer, what also saddened me was that why had it taken such a crisis to cultivate appreciation for what truly matters?

I have struggled with my own identity as a surgeon first and everything else second. One thing I can say without hesitation is that is the wrong way around. Surgery is indeed a vocation. Medicine is a calling. It is not something you do when you have luke warm feelings about it. It is not however, all of who I am. It is not even the most important part of who I am nor of my life.

Recently, a patient about to undergo a major cardiac operation had a wedding in the hospital. It was love that mattered. And that is exactly what matters and defines us, not our occupations. It is the love of your spouse, family, children and friends that is who you are. It is the things you love to do with your time whether that be watching the sun rise, long runs on the weekend or a nice glass of red wine that matter. For all the times I got my priorities and identity backwards, I am sorry. I am sorry for those who fell down the ranking and I am sorry for myself.

I do look like a surgeon and I am a surgeon. A surgeon though, is not all that I am nor all that I want to be. I want other facets to my career and I want the important people and experiences in my life. I want to cultivate a life that is not made up of sutures and blood and ward rounds. And I want to share that life with the people who mean the most to me.

So to answer Eric’s proposition, who would we be if our careers were taken or perhaps freely given? We would be just fine.


Practice “kindfulness”

I met a delightful colleague recently who introduced me her term ‘kindfulness’ which I immediately fell in love with. Her idea that so much toxic culture and therefore toxic outcomes results from a failure of kindness, both towards ourselves and towards others. She advocates for the widespread, indiscriminate practice of kindfulness.

“All I know is that my life is better when I assume people are doing their best” – Brene Brown, Rising Strong

I thought about what she said and realised how much truth there was in this. We are geared up to think that people are doing their worst, that we are doing less than our best. We have become so judgemental and focussed on evaluating and critiquing what everyone else is doing. All this is breeding is toxicity. We judge ourselves for not going to the gym or doing the washing and then berate ourselves to the point where we equate not meeting a task as a reflection on the very fabric of who we are. We missed a workout or didn’t make the bed snowballs into ‘I am an inadequate person’.

Likewise with those around us. The guy who cuts in front of us on the motorway is an idiot and can’t drive. The coworker who constantly leaves early is lazy and useless. It becomes so much a part of our moment to moment conversation, thinking and perceptions that everyone around is not living up to some imaginary standards. Their behaviour escalates into a reflection of all of their behaviour and then everyone else’s and as a consequence, we do not bother to show them any kindness or compassion.

It may not come as a surprise that doctors are a competitive bunch but we’re also tribal. Surgeons hang with surgeons, physicians with physicians and so on. The tribalistic behaviour has given rise to some hilarious jokes and stereotypes. Such as my personal favourite, what’s the difference between God and a cardiac surgeon? God doesn’t think he’s a cardiac surgeon. (Boom tish) These jokes are a reflection of how we judge each other without compassion, kindness or understanding and say all heart surgeons are arrogant, all orthopaedic surgeons are dumb, another specialty is useless at something and the list goes on.

What these jokes, then stereotypes and harsh judgements actually foster is an inability to be kind to each other at times. And when we can’t be kind, we get judgemental. When we get judgemental, we get frustrated, angry or aggressive and significantly less tolerant of others, their behaviours, their flaws and even their successes.

Being kind to ourselves and each other is not just about cultivating the manners our grandmothers spoke of. Being kind and compassionate to ourselves and to each other is good for mental and physical health. Training people to be more compassionate increases their well being, alleviates anxiety and improves their ability positively contribute in a social setting. Being kind to others also increases a sense of self-kindness and wellbeing about oneself. We can happily teach people to be kind and compassionate and in the school setting, this can have positive effects on school safety and development of young minds.

At work, where we are subjected to sometimes long hours of toxic culture, being kind is the correct antidote that we should be using. Showing compassion to others difficulties, whether they be in the office or outside of it increase a sense of well being and therefore productivity. Workplaces that are rife with bullying see an increase in the number of sick days taken and employee turnover, not to mention the development of depression and anxiety in those subject to bad behaviour. Self-compassion is associated with less burnout and anxiety at work, all good for the office but also good for the humans involved.

Kindness is not about being a door mat or standing for poor behaviour, performance or systems; letting that slide is probably going to make you feel worse about yourself and more resentful towards that person and therefore less likely to be kind to them. But perhaps we need to stop confusing strength and aggression and vice versa.

It’s fairly safe to say that what we’re doing to ourselves and each other isn’t exactly working, with rates of burnout, depression and anxiety much higher than most people feel comfortable with. Toxic workplaces are miserable and road rage is a term that is now part of the modern vernacular. So let’s try something different. When someone cuts you off, when someone forgets to do their work or when you have a burger instead of a salad, be kind. Notice it, give them and yourselves a break and carry on.

Or even better, practice ‘kindfulness’ actively. Smile at the person opposite you on the train, wish the barista a good day when you get your morning coffee or offer some help to someone who looks like they might need it. It’s not a massive amount to ask and the dividends may be great.


Kindfulness at the Rio Olympics – the spirit of the games should permeate daily life

Do as I say, not as I do

“Picture me standing on a floor made entirely of glass. If something good happened to me, or if I had a good day with a friend or family, the glass I was standing on would become a bit thicker, meaning that my resolve was stronger and I was less brittle. But if something bad happened, or if I had a setback, cracks would start to appear in the glass. If those cracks ever became numerous enough, the glass floor would shatter and I would fall” – Jerome Doraisamy, The Wellness Doctrines

I have written about mental health (or lack thereof) in doctors on several occasions. The upcoming week or so has two very significant events for mental health. Firstly, September 8 is R U Ok? Day, a day that we are encouraged to ask the people around us if they are doing okay and if they’re not, act on it. Secondly, the AMA(WA) Doctors In Training Wellbeing sub-committee has a symposium coming up on how we can facilitate keeping our doctors well and help those who aren’t overcome their difficulties.

Depression, anxiety and suicide in doctors is rife. US data suggests that 400 doctors per year commit suicide which is the equivalent of losing an entire medical school every twelve months. Beyond Blue has determined that the risk of depression and suicidal ideation is much higher than that of the general community and higher than other professionals. Doctors face an enormous amount of stigma if they suffer, especially openly from the public and their colleagues alike. Despite existing to fight disease, doctors are blind, ignorant or dismissive of this disease in themselves and in their colleagues.

The factors contributing to poor mental health in doctors are numerous. Obviously, a number of doctors who experience depression have pre-existing traits, genes or personality structure that sees them prone to this. When we add into this equation the incredible stress faced by doctors, it’s hardly any wonder. I personally feel like the stress in medicine is increasing, despite the fact that as a registrar, I worked many less hours than my most senior boss, who trained 20+ years before me.

Doctors are now faced with new and difficult stressors including an increasingly competitive training environment, layers of bureaucracy and unnecessary paperwork and exposure to increasingly sicker patients. This in addition to the ‘run of the mill’ stress of long hours, social isolation, long training times as a specialist, relocation, personal cost of training to name just a handful. While hospitals and specialty colleges are offering access to support services such as counselling and moving to combat stressors like bullying, this in itself is not enough.

Most of us do actually realise the significance of these major bodies coming out and saying ‘we understand you need support from time to time’ but we are doing very little to prevent mental illness, target stigma and facilitate meaningful recovery.

A doctor admitting they are unwell is still such an incredible taboo and can be an enormous barrier to seeking help in a timely fashion. There is the ever present threat of having conditions placed on your practice by the Medical Board and having your colleagues be made aware that you are not up to scratch.

Prevention of mental health by truly taking steps to reduce the common stressors in the life of doctors is also an area that needs improvement. Access to part-time or interrupted training may be beneficial to those who are unwell but do not want to leave their training program. Truly developing no tolerance policies when it comes to bullying hospital-wide, not just in surgical circles may relieve some of the stress experienced by our doctors. Successful implantation of wellness programs have taken place in Stanford General Surgery in the USA where surgical residents are given time to go outside, play games and generally destress.

Finally, as a profession that strongly identifies themselves as their vocation, facilitating return to work programs and allowing time off and other access to mental health professionals and programs can help validate the doctor as useful contributor, even in the face of their illness.

The irony of all of this is that whenever I see a patient who to me, is depressed, I have no problems being a compassionate listener and offering the help that they need. As do my colleagues. Doctors, ourselves, prefer to live in a ‘Do as I say, not as I do’ fashion. While we stand silently and let ourselves, our friends and our colleagues be consumed by illness, we fail to offer the help we vowed to take. We also fail to stand side by side with those who need it and let them know that they are not alone and that things can get better.

Nobody really wants to suffer in shame and silence. And so, this Thursday, ask those around you if they are okay. And take steps to be a loud voice for you and everyone around you and demand that as a profession, we start taking care of each other in the same manner we take care of our patients. Mental illness is not shameful, no matter who you are. It’s time that doctors start to take proper care of themselves and for those around us to say that it’s okay to need a little looking after.

Are doctors really sick of their jobs?

I came across this interesting article, shared by excellent podcast The Doctor Paradox. Published in the Wall Street Journal online, the article alerts readers to a very real problem for the profession and the people it lives to serve.

Today medicine is just another profession, and doctors have become like everybody else: insecure, discontented and anxious about the future. In surveys, a majority of doctors express diminished enthusiasm for medicine and say they would discourage a friend or family member from entering the profession. – Wall Street Journal

The article very nicely pinpoints several issues that are perpetuating this disillusionment within the profession. A feeling of being under-valued by society and our governing bodies or employers, a never ending stream of bureaucracy and paperwork linked to that and most worryingly, impacts on patient care.

Despite concerns about income, autonomy and professional satisfaction being a part of this problem, doctors are by and large, quite altruistic people. We hate seeing our patients short changed by an increasingly burdened health care system. And we hate that the burdens being forced upon us are passed along to patients. For example, the WSJ article speaks about administrative tasks directly diminishing patient contact time. In Australia, we have concerns over government funding of health care that will lead to a passing on of costs to vulnerable patients. Our profession exists to serve people. And it is a service we glean much satisfaction from. IMG_6504

That being said, it is time to take this problem seriously. These days, we are trying to make sure everyone feels valued but doctors seem to be getting a slightly different message. The implications for our society as a whole are great if this intense job dissatisfaction continues.

The profession obviously needs to look inwards at itself to see what it is doing to aid such disillusionment. Factors in the workplace such as bullying and discrimination, lack of flexible training options or high degrees of mental stress will not only tarnish our existing doctors but word will get out and we will lose the best and brightest to come other profession. Despite what many of my senior colleagues have said about ‘quitters’ over the years, this is not weeding out the weak. This is our great loss and society’s great loss.

During tough times in our lives, my fellow surgeons often turn to surgical training as a yardstick. ‘If you made it through surgical training, you can make it through this’. And ‘this’ can take many forms; relationship breakdowns, deaths, financial troubles and so on.  Becoming a surgeon should not be used as the yardstick by which we measure all of life’s problems.

As a profession we also need to take charge of our destiny. Take a look at the great efforts by the doctors of the NHS in the junior doctor dispute. They came together as one profession and said that they were no longer going to be taken for granted and most certainly, they were not going to put their patients at risk for the sake of politics. Health systems the world over have a lot to learn from this dispute.

Perhaps the most serious downside, however, is that unhappy doctors make for unhappy patients. Patients today are increasingly disenchanted with a medical system that is often indifferent to their needs. – Wall Street Journal

We are altruistic and we do care about our patients. We also care about ourselves and our own families and the extraordinary sacrifices we have made for our profession and our patients. The fact that we are not alarmed as a society by the breaking of our health care workers is a sad indictment on our approach to modern life.

Our medical students and young doctors need to be mentored authentically to demonstrate professionalism but also learn about career planning and self-care. We should examine our training processes to ensure that we are doing everything we can to retain people even if that means moving away from trying to break our trainees. And lastly, the profession needs to bring our goals together and ensure that we have a strong hand in shaping a system that works for patients and doctors alike.

Our system is approaching breaking point and the dedicated health care workers from all fields who prop it up won’t be able to for too much longer. So now is the time for action to sustain our health care system into a long and caring future.

Critics, courage and compassion

wonder-woman-1016324_1920“It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes short again and again, because there is no effort without error and shortcoming; but who does actually strive to do the deeds; who knows great enthusiasms, the great devotions; who spends himself in a worthy cause; who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who neither know victory nor defeat.” – Theodore Roosevelt

We would all like to describe ourselves as strong, tough or resilient. We would like to think that when life gives us lemons, not only do we make lemonade, we do it with fortitude. We look the problem in the eye and we go for it. We take no crap and suffer no fools. And in the end, the triumph is ours.

I have been reading the most fantastic book recently, ‘Rising Strong’ by Brene Brown. In it, social worker and PhD researcher Brown talks about the value of vulnerability in strength and overcoming adversity in life. In both the big moments and the day-to-day hiccups. The crux of Brown’s approach is exactly as Roosevelt states. Courage is not winning, courage is ‘being in the arena’, it’s dusting yourself off and starting again. It’s turning up even when you’ve been beaten down.

The concept of strength to me has always been that typical Type A response. Attacking the problem head on with huge amounts of gusto. Now though, I think that most of human achievement actually comes from the moments in the arena. It comes from the moments when we have to show faith or hope or vulnerability. That kind of exposure of yourself is much greater than the exposure of grabbing a bull by the horns.

“Vulnerability is not winning or losing; it’s having the courage to show up and be seen when we have no control over the outcome” – Brene Brown, Rising Strong

The concept of strength being about brute force rather than the gentler vulnerability and quiet, persistent courage is a barrier to real happiness and real success, both personally and professionally.

It is the falling short of our need to win that creates a dangerous workplace culture when we take our shame and frustrations on someone with less power than us. It stops us from seeing what our emotions truly tell us that we want. It stops us from asking for what we need and want in life. It’s the pride that lands us in more trouble when we don’t ask for help. It’s the isolation from our family and friends when we don’t communicate what really matters to us.

The real strength lies in compassion. Compassion for ourselves and the hurt that we experience. Compassion for others so that we might see that they are trying their hardest or are imperfect, even when they fall short. Their best may not be our best or even in our best interests, but when we look at what has happened with compassion, life is a little easier. And rather than pure anger or some other Type-A response, we can grow ourselves and maybe even help with the growth of others.

I wish I had known more about just being in the arena before now. About the power of vulnerability and compassion. I think it may have made me a better person, a better partner, a better friend and a better doctor. In our society, we might earn to grow together if we start seeing the world not in terms of winning or losing but of the power of showing up and being real. We can act from a place of authenticity and integrity and I don’t know about you, but I think that will definitely help me sleep at night.

Generation gap or Generation chasm?

Gap (noun) A break or hole in an object or between two objects:he peeped through the gap in the curtains

1. A pass or way through a range of hills:
2. A space or interval; a break in continuity:there are many gaps in our understanding of what happened
3. A difference, especially an undesirable one, between two views or situations:the media were bridging the gap between government and people
It is entirely natural for each generation to differ from each other. Each generation is subject to different social, spiritual, political or financial pressures. This is what we would commonly refer to as a generation gap. It is a difference in opinion between the politics, beliefs and values of two generations.
Chasm (noun):
1. A deep fissure in the earth’s surface:a chasm a mile longfigurative he was engulfed in a chasm of despair
2. A profound difference between people, viewpoints, feelings, etc.the chasm between rich and poor
The forces acting on a generation vary widely, with crises such as war, recessions or great political unrest acting on people to shape their views and values. For example, war time was a great definer of ‘The Great Generation’ who are World War II veterans where political and financial uncertainty defined these people. Compared with their offspring, the Baby Boomers, who compared to their parents, grew up in a time of relative stability and financial security. No two generations have the same experiences and this is therefore reflected in their outlook on the world.
Here in Australia, the generation gap between Baby Boomers and Gen X/Y/Millenials is getting a great deal of attention, especially in an election year from young voters. As around the western world, there is a great deal of thinking about how Gen Y has found itself in a precarious position as a side effect of the successes of the Baby Boomers. Specifically, Gen Y members may be bringing up the rear when it comes to housing affordability, employment opportunities. In addition to this, the sheer number of ageing Baby Boomers who will be reliant on public services such as health in the future will lead to very significant financial strains on the population.
Unsurprisingly, the perceived face off between Baby Boomers and Gen Y is somewhat controversial. As expected, it’s not too hard to find a Baby Boomer who feels that Gen Y are a bunch of lazy, entitled brats who enjoy nothing more than complaining. Likewise, Gen Y may be tired of being dictated to by conservative and selfish leaders who have no interest in the opinions of the younger folk. And no more now in Australia. Aside from concerns over housing prices, lack of job security or personal wealth, the current federal election has seen many younger voters feel entirely disenfranchised by a system that does nothing to help us achieve our goals, as the Baby Boomers have been able to do.
The workplace is a fertile battle ground for the inter-generation war. Baby Boomers hold positions of power at many of the organisations that Gen X/Y/Millenials are employed at. The workforce is ageing, leaving many younger people without jobs that they have trained for; graduate unemployment is at an all time high in this country. Baby Boomers value experience and graduated climb up the corporate ladder; Gen Y want to be recognised in a kind of meritocracy where ideas matter, not length of service. Baby Boomers were a generation of long work hours and immense personal sacrifice while Gen Y value hard work, but also value personal or family time. Ageism exists in the reverse also, with older workers struggling to get back into the workforce. You could not have two more different groups, trying to work together.
The friction created can be immense. The battle cry of the Baby Boomer, ‘They’re nothing like us’ is both right and wrong at the same time. No, we are not like you. As Baby Boomers were not like their parents’ generation either. But that does not mean that we don’t want the same things. We want job satisfaction, we want appropriate renumeration and recognition for our work. We want to achieve and do a good job.
The similarities should get us to the table. The differences between the generational workforces should be embraced. Time Magazine, the New York Times and Forbes have all written on the generation gap at work and the common theme is this. We ALL have something to offer, something to learn from the other and we all have biases. Workplaces work better when we realise that although we may need and want individual recognition or advancement, we work together, not in isolation to a common end.
In this election year, our politicians seem to have forgotten the value in collaboration. With Gen Y having the ability to be the deciding vote, the lack of commitment to matters that are the heart of this generations concerns is short-sighted and selfish. This can be reflected in the unwillingness of Gen Y to even enrol to vote; it is not laziness but rather symptomatic of a widespread disillusionment with our elected ‘leaders’. The values that matter to younger Australians barely get a mention. Housing affordability, refugees, environmental concerns, gender and race equity and marriage equality are back burner issues.
The generation gap is in my opinion, an understatement. The generation gap in the workplace is making an entire generation feel impotent as Baby Boomers hold on to the reins from it’s ‘lazy, greedy’ successors. The generation chasm created in politics on serves to further disable young Australians to experience the fulfilment that Baby Boomers have had. Just as their parents thought them, Gen Y is not like the Baby Boomers and not in a good way. It is long past due that Australians, not generations, work together to create some equity between generations and create a stable future for all Australians.