Professional women’s groups: whingers or winners?

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Are we really working together for a greater good or just having a bitch and moan?

At a recent gathering of colleagues, we were discussing the upcoming meeting of a women in surgery craft group. A few said they would be attending, some could not but one voice said something I wasn’t exactly expecting. A similarly aged female colleague said ‘I never go. It’s just a room full of whinging women’.

This isn’t the first time I’ve heard someone say this and certainly not the first woman I’ve heard say this. I have to be honest, it always shocks me a little. Although my surgical workplace remains a male-dominated field, some women have better experiences than others, some a lot worse. However, using the term whinging implies that those bad experiences are being blown out of proportion or imagined.

The bold statement that implied women’s craft groups are nothing more than a group vent made me think, are they really relevant or are we just whinging?

Surgery is not alone in the presence of female-orientated craft groups. Virtually all professions where men have traditionally held those positions have one or more. Women in Surgery, Women in Media, Women in Engineering, Women in STEM, Women in Law,Women in Aviation and even the defence force has a section dedicated to encouraging women into their ranks. On numbers alone, you would have to imagine that these organisations must exist for a reason and do function in a positive manner.

In these diverse fields, women are particularly underrepresented, especially at the higher echelons. Women make up around 10% of surgeons and in a very public investigations, around half of women in the field reported some form of bullying. Others reported discrimination and sexual harassment. Only three women have been appointed to the Supreme Court, loss of women in STEM during their 30’s and 40’s sees them underrepresented at higher academic appointments and across the board, difficulties with breastfeeding, parental leave or career progression are common.

Strength in numbers is so useful to women who may want guidance or mentoring. It is great to be validated by someone else in a similar position that the problems or successes you experience are not just limited to you. You are not alone. Women’s professional groups have the ability to share advice and offer support. At the risk of sounding a little but of a hippy, at the very least, within these groups a safe space can exist to share some of the not-so-good times.

They can explain how they manage child care with work, or how to make a workplace breastfeeding friendly. They can share advice on how to break the good old glass ceiling and support, mentor and facilitate the advancement of women through their ranks. Personally, I think they are an excellent resource to network, mentor, support and even socialise.

Women’s professional groups do have some distinct advantages for their members. This includes locating a mentor that the mentee can identify with, providing both guidance and inspiration in navigating the workplace. When used appropriately, this can be of great advantage in an increasingly competitive workplace where connections matter. These groups often advise overseeing professional bodies on matters that effect everyone including workforce diversity or flexible working hours and leave policies. Whether you be male or female, member or not, a lot of positive improvements in the workplace have come as a direct result of the influence of professional women’s groups.

That’s not to say that these groups sometimes underperform. Especially in workplaces where gender equality is not as advanced, these meetings can indeed have a tendency to become all about venting the problems we all encounter. In addition, just by existing or having a large group, that in itself won’t change systems weaknesses or unconscious biases. Women’s professional groups also have to develop achievable action plans that can actually perform at work.

Professional women are also very adept at keeping their heads down, so as not to create any trouble that might hamper their career. Associating yourself with your women’s section may wrongly identify you as a feminist, troublemaker or ‘humourless bitch’. Regardless of the fact that we have every right to have our concerns heard and changes made. Nobody wants to be seen as a troublemaker and troublemakers are at risk of not being employed or looked over for promotions. Whether it is true or just, women’s professional groups can indeed seem a little scary to those of us who are just trying to survive.

That being said, I don’t think that we should stop voicing our concerns. Perhaps a meeting of women in surgery or engineering or any other group is full of ‘whinging’ because we have along way to go. It may be a sign of disempowerment of women as individuals at work, in society or as a group as a whole.

I don’t buy into the philosophy that we should support other women, at all costs. The saying ‘there’s a special place in hell for women who don’t support other women’ is just another way to exclude someone who may have a different opinion. We should support each other and not pull the ladder up behind us, however, disagreeing and having the tough conversations will only improve things for women. Nodding along with whatever is said, including the existence of women’s groups, can lead to us missing the important and uncomfortable topics that need attention. However, blanket labelling of feminists and women’s groups as ‘whingers’ belittles the experiences that some women have had at work.

I strongly believe it is important that these groups exist and continue to undertake the excellent work that they do, not just for women or its members, but for our entire workforce. A diverse workforce is without a doubt, a more efficient and productive workforce. Instead of choosing our doctors, lawyers or pilots from a proportion of the population, we get to pick them from the whole population. Imagine the talent we could discover!

It is also important that women’s professional associations do not become echo chambers of professional women listing the vast number of problems faced by them in the workplace. To be honest, I don’t think many just do that. They have absolutely been positive vehicles for change, not just for women but for entire professions. Continuing to use our collective voices, women’s professional groups can lead the way to create workplaces of the future that are inclusive, productive and successful.

Being a doctor is nothing like Grey’s Anatomy: Part II

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This is why we wear masks. Just saying.

Just when you thought it was safe to turn on your TV…

Just when you thought your TV show had hired a medical consultant…

Just when your neighbours thought you had stopped yelling at the screen…

It’s time for part II of ‘Meredith Grey is not real life’.

House MD: Where are the nurses, allied health professionals and ward clerks?

I have already given House a hard time in my last article but considering it’s a repeat offender, it deserves a repeat mention. Aside from the fact that House and his team of ultra-talented doctors appear to be the only physicians working at Princeton-Plainsborough, they are flying solo. The nurses portrayed in this series are not only few but they seem to only serve to give House dirty looks. Real life is much more diverse. We all work in multi-disciplinary teams where each professional brings a special set of skills. the nurse for example, may not do surgery, but equally luckily, the surgeon will not demonstrate physical therapy. It takes a village to heal a patient.

The book ‘Blindsighted’ by Karin Slaughter: Not everyone cracks a chest

In this series of books focussing on small town coroner/paediatrician where an unnerving number of murders take place, the drama seems to win out over accuracy. In the first book of the series, the protagonist opens a young woman’s chest to give internal cardiac massage. Of course, she survives. TV shows, films or books often make it sound like we are all ready to give anything a go. In reality, doctors are not. We make calculated, educated decisions not just based on knowledge but our own skills and specialties. And when a situation is above our skill level, we call someone who knows what they’re doing.

Every TV show/medical movie ever: If the supply closet is rocking, don’t come knocking

Just no. There are rumours of hospital staff shall we say letting off steam, but most definitely not with the frequency of TV shows. If we were all at it as often as the doctors of Grey’s Anatomy are, there would be no time to get work done.

Every TV show ever: We all hangout after work at the pub over the road from our major teaching hospital

Going back to this concept of time, we are tired. Most of us at the end of the day just want to go home, eat food that is not from the hospital cafeteria and sleep. Before you are a fully fledged specialist, we race home to study for specialist exams. Basically, we are boring and responsible. However, when the time does come, we do know how to have fun and hang out with the people you spend most of your life with.

Grey’s Anatomy: Relationships with patients are frowned upon. Especially if they leave you a large inheritance.

Back to Izzy and her drive line cutting, doctors are held up to a very strict code of conduct and having a relationship with a patient is a major no-no. We are in a particularly privileged position, the patient in a very vulnerable position and these rules exist to protect the patient from being unduly influenced. In Australia, even receiving gifts from patients is subject to strict rules and require reporting of the gift to your hospital.

House MD & Grey’s Anatomy: You can’t be rude to patients or other staff and expect to get away with it

From the time Cristina Yang screwed up and organ donation request to every time Gregory House interacted with another human being, the tolerance for being rude is pretty low. Especially to patients, no matter what the circumstances.Patients (rightly) complain about doctors (or other staff who are rude to them) and increasingly, within the medical profession, we are becoming less tolerant of poor behaviour from our colleagues. Whatever the situation or reason, the patient suffers when behaviour is poor and that is just not okay.

Catch Me If You Can: I concur, you can’t pretend to be a doctor.

Ironically, one of my favourite TV shows is Suits about a guy pretending to be a lawyer which I’m sure is pretty unlikely. Pretending to be a doctor would be tough. Even as a fully qualified doctor, any time you want to work somewhere or perform a new procedure, boards or committees scrutinise you very closely to ensure that you are who you say you are. Rocking up and nodding along sagely with a senior clinician will net you a trip to the police station.

Casino Royale: After a cardiac arrest, James Bond is back to saving the world

Mr Bond, it pains me to tell you off. Especially after that scene in that film. And you always get your man. But let me be clear here, people do not have a cardiac arrest, shock themselves (sort of) and then just clean up and carry on with their day. If you survive a cardiac arrest, you can be sure that you have booked yourself a hospital stay to find out what happened and how to stop it from happening again.

Heartbreakers: Melissa George was never covered in bone dust

To be fair, I have not yet watched Heartbreakers, based on real-life transplant surgeon and author Dr Kathy Magliato. In her interview about how she saw real-life heart surgery, George says that she was covered in bone dust after a tough day of scrubbing in. No she wasn’t. I promise you, she wasn’t. Heart surgeons in particular pride ourselves on being neat and tidy for one. Secondly the sternum opens without much fanfare at all. Maybe she was gunning for ratings? Either way, it’s generally not as glamorous, dramatic or messy as TV and TV stars make it seem.

 

Tell me what else drives you mad – I’m sure there are hundreds of them!

 

 

How tired is too tired?

InstrumentsMany years ago, I was working as a registrar in plastic surgery. In this unit, we did a lot of complex head and neck reconstructions for cancer. One case I remember especially well was a wonderful lady who had a particularly nasty cancer on the floor of her mouth. She was scheduled for surgery on a Thursday. Thursday was reconstruction day. We started her operation around 8am, finished around 5am on Friday morning.

I raced home for a quick shower, got changed and came back to work. No sleep. A lot of make-up. I came back into the ICU to see our lady and the free flap reconstruction was not looking great. It was likely that there was some problem with the blood supply of the tibia, muscle and skin we had borrowed to reconstruct the defect. An hour of trying things like manipulating blood pressure, taking pressure of the neck and heparin to dissolve any clot didn’t work and so we headed back to the operating theatre to revise the flap. It was about 5pm on the Friday when I realised I had fallen asleep on the operating microscope.

This is not the first or last time I had been awake for several days. I am overly familiar with the reasons sleep deprivation is used as a form of torture. It is awful. In surgical literature, there has been a growing body of evidence that suggests sleep deprivation can be associated with mistakes made, especially by junior doctors. They are also at risk for traffic accidents, needlestick injury, burnout and other mental illness. Work-life balance is undeniably important.

In Europe and in the United States, working hour restrictions were brought into place to try and improve the safety of patients and doctors. In Australia, we have shift length restrictions and minimum breaks but in my experience, some hospitals play fast and loose with these areas of the award. 24 hour shifts still exist.

The European and US restrictions do have some drawbacks in surgery. Firstly, the increased number of shift changes may mean that a patient’s care is ‘handed over’ to doctors resulting in the potential for Chinese whispers of the medical variety. Errors can be made each time we tell the story again, things forgotten. For training purposes, the reduced time on the ground may decrease training numbers and exposure to emergency cases.

An ambitious study was released today in the New England Journal of Medicine where investigators looked at the ACGME-compliant group versus a group with more flexible work hours. The main differences was that the conservative group couldn’t have shifts over 16 hours (24 hours for more senior doctors) and had to have 14 hours between shifts. The flexible group could work over the 16 and 24 hour limit and did not have to have a 14 hour break.

Flexible working hours were not associated with any increase in adverse events, which is very reassuring. The flexible group residents did also not report any dissatisfaction with educational opportunities and were less likely to leave during an operation. The residents didn’t report any adverse personal outcomes to working more hours.

What is very interesting about this paper is that the residents involved were not aware nor were they consented. Neither were patients, when care may have been affected. In my opinion, this is an ethical whoopsie. It may have changed outcomes as doctors changed behaviour or perception, but medical research is not in the business of not consenting its subjects.

Other data which would be great to see was not picked up would be incidence of needlestick injuries, a validated burnout scale or longer term well being or skill acquisition data. I think these things would make for a fascinating look at the effects of the things we do to ourselves.

I think work hour restrictions are actually important for training doctors. The weight of evidence to suggest that tired people are sad, burnout, dissatisfied, potentially error prone, divorced, unhealthy and so on is quite strong. We all know someone who has had a near-miss or actual accident being so tired after work. I had a bike accident one day, coming home from a long shift. I was too tired and didn’t see the car pull out in front of me. An obstetrics registrar was killed in an MVA, a plastics registrar hospitalised. I don’t know many surgical trainees or surgeons who haven’t woken up in their cars, nearly underneath a bus.

That being said, I also believe that it is important to know how to operate when you’re tired. Someone’s life is going to depend on that one day. The first time you’re doing an emergency procedure after a long day shouldn’t be when you’re out on your own. I also think that handing over mid-operation is not good for patients or doctors learning. Some flexibility must be afforded to experience emergency, tired and middle-of-the-night surgery. It should not, however, be the norm.

As with most scientific literature, we don’t usually change practice based on one study alone. That should be the case here. More information is needed so that we can find a ‘sweet spot’ where the needs of both doctors and patients are looked after.

Back again in my plastic surgery days, those hours were long. We operated most nights, not just on true emergencies, but on urgent but not emergent cases. We needed to get the work done because there was no other time. On call for plastic surgery rarely meant home before midnight and back at 5am.

One night, I went to see a patient with the senior registrar. This man had been waiting to have a second operation on his hand after an injury. It was around 7pm and we were hoping to do him around 9 or 10pm that night. My senior told the patient this and he refused to consent.

“I’ve seen you here after midnight every day this week, mate. You’re too tired”

The senior was seriously jacked off that his competence had been called into question.

In all likelihood, had he had his operation by the tired registrar that night, it may have gone well with no problems. In medicine, we try not to play too much with ‘may have’ or ‘she’ll be right mate’ because when it comes to people’s lives, close enough is not good enough.

Close enough is not good enough for our patients or our doctors. It is incumbent upon us to work out what is good enough.

Feminisation of the workforce: truly a problem?

This is a copy of a letter I am sending to the editor of the UK Newspaper The Times following an editorial by a Dominic Lawson. The article is available at http://www.thesundaytimes.co.uk/sto/comment/columns/dominiclawson/article1656813.ece

Dear sir (or madam, because I hold hope that a woman may be employed by The Times),

As you may know, social media has been quite intrigued by the article written by Mr Dominic Lawson entitled ‘The one sex change on the NHS that nobody has been talking about’. Mr Lawson’s article is placing the blame for workforce issues, including the current junior doctors’ contract dispute, squarely at the feet of the female doctors in the NHS. I am writing with both a strong rebuttal but also to express my extreme offence at the article.

My background is that I am a female doctor and moreover, I am a female heart and lung surgeon who practices in Australia. The shockwaves of this article have reached that far. In this country, our own regulatory bodies including the Royal Australasian College of Surgeons have gone to great lengths to investigate and move towards a medical workforce where opinions in the style of Mr Lawson are regarded as discriminatory and antiquated. 2015 has begun an era in Australia and more specifically in surgery when we will no longer tolerate sexism.

It is remiss of anyone to think that women alone are responsible for any issues related to work-life balance. Men also wish to be a part of their children’s upbringing just as much as their wives.  Both male and female medical graduates make informed decisions about their career choices based on this. Many professions are now pushing for safe working hours and balance in one’s life. This balance is so important for the physical and mental well-being of employees and is much more likely to yield productive employees. It is extremely inaccurate to say that this solely an issue of ‘feminisation of the workforce’.

‘Piling up’ in accident and emergency wards has very little to do with doctors and a lot to do with the health workforce at large. Casualty is subjected to enormous pressures with patients who are increasingly complex, unable to access their overworked and under resourced general practices and hence overflow to emergency departments. Understaffing of orderlies, laboratories, radiology, wards and bed numbers at capacity are a real problem. Citing this as a side effect of graduating more female medics suggests that Mr Lawson has failed to grasp the actual issues that face a modern workforce and more specifically, that are faced in health care today. I would suggest that these issues are not only more real, but much more deserving of an editorial.

The general tone of the editorial is insulting to doctors like myself, who are consummate professionals, who are highly skilled and would get out of bed at any time for a patient who needs our care. It is an insult to the hours we have all freely given (in a financial and social sense) to the practice of our craft. In 2016, there is absolutely no place for editorials that are inflammatory and sexist. Maintaining a healthy and balanced workforce must be discussed. We should discuss how to accommodate maternity leave in a professional manner, not in the pages of a newspaper, with approaches for real workable solutions, not blaming one group for a problem.

Mr Lawson has mentioned that his daughter may take issue with his opinion. I honestly hope that she does. More importantly, I hope that Mr Lawson keeps in mind how he would like someone to speak of his daughter’s skill, commitment and achievements in such a fashion as he does to mine. I doubt many fathers would truly be happy with their offspring being spoken of as he has done to me and my female colleagues across the globe.

 

Sugar, sugar: Should we ditch the sweet stuff?

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Close up of woman with pink lipstick licking sugar covered lips

In case you hadn’t got it, the first part of the title of this blog should be sung. You know the lyrics:

Sugar, sugar (da da da da da) Oh, honey, honey. (da da da da da) You are my candy girl… 

Apologies, I digress.

I am going to let you in on a trade secret. Doctors eat crap. Well most doctors do. Especially younger doctors. It’s a multi-factorial problem that is ably aided by long work hours, lack of time to develop decent culinary skills, every ward in a hospital having treats, hospital food tasting like a foot with very little nutritional value and being really bloody tired.

I had very busy couple of days of work recently where I think I only slept single digits over the course of 48 hours. So I was shattered. And when I’m tired, I eat awfully and usually in my car. On my return home, when I had finally left the hospital, I was forced to remove the bags of empty take-away from my car.

The funny thing is that I live in the health-nut headquarters of Australia, where kale juice and superfoods reign supreme. So in front of slim, anti-oxidised passers-by, I very shamefully took the evidence of my crime to the bin. If they knew that I was a doctor, I wonder if the shame would have resulted in an emergency admission to a health food retreat for immediate reprogramming?

Anyway, as a heart surgeon, I deal with the consequences of our lifestyle choices day in and day out. I look after patients who meet the criteria for morbid obesity, who have blocked coronary arteries or who have lost limbs  due to peripheral vascular disease. Not only do I indulge in foods that I shouldn’t more than is recommended, my own understanding of nutrition is frankly, dodgy.

Medical school did cover some nutrition but not a lot. I get that. When you have to cover an entire human body and all of its functions, some stuff has to go. Plus, we have our extraordinarily learned colleagues, dietitians, to steer us in the right direction and give sage nutrition advice.

But what about me? What about me and my nutrition? What about the fact that I should know how to advise people when they ask what to eat after bypass surgery to make sure they don’t meet me again? (Most don’t by the way) What about my own health?

This week, I saw that iTunes’ weekly 99c rental was That Sugar Film made by Australian actor, Damian Gameau. So I decided to watch it, with the hope that it would start 2016 out for me with a good change in my own diet and more knowledge about what we should all eat.

I accept that as a society, we eat too much. We also probably eat too much sugar. Along with saturated fats and low levels of macronutrients and micronutrients (vitamins, minerals). That aside, I find the whole no-sugar, in fact a lot of ‘diet’ movements to be distasteful. I find their science to be quite shaky, they often advocate removal of foods or food groups that have good nutritional and medicinal value and their claims outside of maintaining a healthy weight lack evidence. So I went hunting for more information, specifically on sugar. While this a very simplistic view point, I hope it might be a starting off point for my own sugar and diet knowledge.

What is sugar?

Sugar is not just the stuff on the table you add to your coffee. The term sugar encompasses glucose (found in carbohydrates), lactose and galactose (found in milk), fructose (found in fruits) and in combination with glucose, sucrose, a disaccharide. When sugar consumption is being regulated, we are looking at that which is added in excess of naturally occurring. There is no good evidence to support that sugars occurring in foods such as fruit in a natural unprocessed state is the devil.

Glucose is a very important substrate. It is the cells’ currency for energy production. The brain in particular, is highly dependent on glucose for normal function.

What is the problem with sugar?

Energy excess, whatever the source, is not great for our health and wellbeing. However it happens, whether it be from too much fat or too much sugar (of any form), if you have too much of it, the body will store it as fat. Consuming too much sugar is being increasingly recognised as an independent risk factor for cardiovascular disease, diabetes, hypertension and liver disease.

The argument is ongoing as to what forms of sugar are truly naughty. We also have not locked down whether all calories are created equal. That it is, is sugar truly toxic or is it just an energy excess that excess sugar consumption causes that hurts?

What about fat?

Fat has generally been blamed for all of our health woes in the past. It’s likely that this was an over simplistic view of things. It’s generally well accepted that saturated fat is linked with increasing levels of cholesterol and tryglycerides in the blood (not good). The recommendations now support using monounsaturated fats such as olive oil, seeds, avocado, fish to make a patient’s blood lipids more in line with health. Fat can also help us feel fuller for longer as fat delays gastric emptying.

So how about fructose?

Poor old fructose. Fructose is the naturally occurring form of sugar that we eat in fruits. Fructose is getting a seriously bad rap at the moment, bearing the weight of all, well, our weight issues.

The movie That Sugar Film points out that naturally occurring fructose in fruit is accompanied by fibre. Say an apple or some berries. The fibre aids in making us feel sated, and fibre is important to regulate bowel health. (Ask someone who eats loads of protein and no fibre about their poos.)

Some evidence (from rat and short term human studies) have placed the blame for “toxic” sugar effects squarely at the feet of fructose. It has been linked with diabetes and insulin resistance, gout and obesity. The science behind this is thought to be due to the liver’s handling of fructose. It may more readily convert it into fat.

The fact is with regards to fructose, the studies are not based on super strong science. The levels of fructose in some studies are much higher than the ‘average’ person consumes for example. I also have a real problem with the promotion of quitting fruit to reduce fructose consumption as fruit had many excellent benefits to health. I’m eating a punnet of blueberries right now! Not only are they tasty, they’re stopping me attacking a block of Dairy Milk. Win, win.

How much sugar should we eat?

A few months ago, the WHO published guidelines to suggest that total energy intake should not have more than 10% of free sugars – that is added sugars. Not sugars found in fruits, vegetables, carbohydrates. However, for optimal health, we should be aiming even lower to 5% which equates to 25g of sugar or 6 teaspoons of sugar per day.

That is not much (bye bye Giant Freddos)

Nope. It’s pretty small really. But bear with me. Here’s some sugar contents of popular foods.

Can of coke (375mL): 39g (oh my goodness)

Light strawberry yoghurt: 14g

Clif Bar: 21g – damn. I loved these for emergency breakfast.

McDonalds Cheeseburger: 7g

Tomato sauce: 4g (for a 17g/tablespoon serving – I use more than that)

Strawberries (punnet): 7g

So all in all, what’s the deal?

  • Obesity sucks big time in terms of getting sick
  • Our understanding of nutrition is constantly evolving, so this may change again in the future
  • Sugar is not the only lifestyle problem – we eat too much in general
  • Smoking and inactivity also are strongly linked to cardiovascular disease
  • Too much sugar is not great for you
  • Fructose – the jury is still out
  • Fruit is good for you so don’t give it up
  • Evidence for mood swings or depression and sugar is not great
  • Superfoods are non-essential food items, eat them if you like
  • I am going to miss Giant Freddos

I am going to be much more conscious about cutting out excess sugar in my diet. And excess take away. However, I have a major problem with the terms good and bad when referring to food. I think the psychology behind it, for me at least, is harmful. And I like food, I like sugar. I want to have an actual birthday cake, not one made of kale. Yes, I really have it in for kale, I do not like the taste one bit!

I think it’s important to get our information on diet and exercise from reputable sources. I mean no malice in this statement, however, a lawyer/actor/wellness blogger may not necessarily have the tools to correctly identify the plethora of information about this kind of thing. We have seen countless examples of how these people can miss the mark a little. Or more than a little.

For me, I am going to continue my research into food and sugar. I’m interested in it for my own well being, my patients and I think I can make a good go of the literature. That Sugar Film has prompted my reading and noted that excess sugar probably has a role to play in obesity and disease. But the science is lacking. If it helps people rethink their choice, great. But this just ain’t gospel I’m afraid.

For further reading:

This great blog from Scientific American: http://blogs.scientificamerican.com/brainwaves/is-sugar-really-toxic-sifting-through-the-evidence/

JAMA: http://archinte.jamanetwork.com/article.aspx?articleid=1819573

BMJ: http://www.bmj.com/content/346/bmj.e7492.full.pdf+html

http://www.slate.com/articles/health_and_science/medical_examiner/2015/08/that_sugar_film_science_debunking_links_to_mood_health_fatty_liver_disease.single.html

Wendy Zuckerman’s great podcast Science Vs. did an episode on sugar: https://soundcloud.com/science-vs-season-1/sugar

Q&A on Fructose: http://bmcbiol.biomedcentral.com/articles/10.1186/1741-7007-10-42

Mirenagate

Full disclosure – I have unashamedly stolen “Mirenagate” from Dr Eric Levi. (@DrEricLevi) He has also written a great blog on this piece, specifically as it relates to social media.

Aussie medics on twitter especially, would be aware of the article posted in the Australian newspaper on the 2nd of January relating to obstetrics and gynaecology trainees. The article related to a debate topic at a college branch meeting in the next month about women in training and how they should manage their fertility. As one might expect, the suggestion that childbearing should be regulated for the course of specialist training was not taken very well by a lot of people. In fact, it was so badly received, it left a lot of people asking why in the world someone would let the debate topic exist in that form.

I should take this opportunity to point out that a number of obstetricians suggested that the debate topic was supposed to be a humorous way of talking about a serious topic. The RANZCOG president was quoted as saying he wasn’t aware of the topic, thought it was tongue in cheek and will address it. Even with that in mind, people were still not exactly impressed. And remain so; this has really struck a nerve.

“Mirenagate” has really brought to light a few issues, all of which are very important and some of these issues have failed to been addressed not just in this scenario, but by medicine for years.

Women have long suffered innuendo or genuine discrimination in medicine due to their reproductive choices. I know of women who lied about their children existing, were bullied when they fell pregnant during training, have been given no consideration due to illness during pregnancy, have worked heavy rosters up to the late stages of pregnancy, been asked about their intentions with children for references/training intentions and so on. And let me very clear, not all of this happened in surgery. It is rife in medicine, I’m sure in a lot of professions, that women may be perceived as having less entitlement to a career or a position due to pregnancy.

Now I understand that this is not always the case and that employers and colleges have been understanding to some groups or people. But to women who have suffered bullying or discrimination by virtue of their gender of their children, it’s not hard to see how even in jest, this suggestion could be very offensive.

My friends and colleagues who have undertaken training with RANZCOG have spoken highly of the support they have received when they have had children. The RANZCOG policies are more robust than other training institutions for part-time and interrupted training. If they are going to truly talk about the difficulties for trainees, employers and the college alike when interrupted training exists, then that is a good thing. However, the choice of topic title may have been better stated to take into account the large numbers of women who have been the subject of bullying and discrimination in medicine. The very public RACS investigation and media coverage on this same matter in 2015 should have taught us that we have a group of doctors who have been terribly treated and harmed in the pursuit of their profession.

The other issue that Mirenagate uncovered was the importance of being the master of one’s own domain. As often is the case, this story was all over Twitter very quickly. Unfortunately, it seemed that RANZCOG did not have a social media presence here and missed many of the issues raised and the extreme disappointment at this issue. I tweeted my own disappointment, especially in the setting of my perception that RANZCOG was doing better than most. This topic also started off a conversation online of the difficulties many women have faced in training, not just in obstetrics but surgery, medicine and other professions. Not all of the backlash online was directed at RANZCOG but was a sharing of other’s experience with pregnancy in medicine. Being online, RANZCOG may have understood what all the fuss was about.

Having a social media presence I feel is not only important for individual doctors, but this demonstrates how important it is for RANZCOG or other colleges. They may have been able to mitigate some of the damage early on. They (and other colleges) could get a strong sense of what a difficult issue this is for a lot of doctors and hear some of the stories women were sharing. Being involved or observing the conversation can allow important change to take place. It is important to be a part of the social media sphere to control the conversation people are having about you, to you or that involves you.

I hope that RANZCOG have a great meeting with meaningful discussion about issues their trainees face. I would also hope that we all learn from this experience. Some of us will learn that obstetricians, by and large do not want their registrars to have Mirenas. Some of us will understand that the media love a headline. Some of us will learn about the struggles faced by trainees and how we can provide better training for our doctors. And definitely, I know RANZCOG will now be tweeting a little more.

Medicare is sick

In case you have missed it, the Australian government is undertaking a review of Medicare, or more specifically the Medicare Benefits Schedule. The MBS is a list of codes for procedures or consultations, delivered by health care professionals that have a cost associated with them. Social media has been quick to pick up on a slightly underdone news report by the SBS about some procedures that are set to be axed.

Let’s be very clear about something. Medicare is sick. This country is in desperate need of a wake-up call that the public (and to a lesser extent, private) purse is not a bottomless pit, even for vital services such as health care. The MBS desperately needs to be properly and thoroughly reviewed with appropriate values assigned to procedures and delisting of procedures that have no scientific basis. We need to start rationing the health care dollar in order to get the best from it.

We are all healthcare consumers and we should all care where our money is being spent. Think of it like this. While we are wasting money on one thing, say a procedure that may not work, that money could be missing to find a procedure that does work. It’s like buying a pair of jeans that don’t fit properly, then when you go to buy some that do, the cash is not available. Our entire country should start thinking about how we spend our money and ensure we get bang for a our buck.

The MBS has been around since 1984 and currently lists codes for around 5700 procedures. Some procedures that are still listed are no longer utilised as they have been superseded. Not all procedures are what we call ‘evidenced based’ where the best possible scientific evidence has been examined to determine when, where and for who we are supposed to use a certain intervention. Some procedures are grossly overpriced and some procedures are grossly underpriced. The MBS has become a matted tangle of codes for procedures that have not been revised since their addition. At the same time, medical care has been advanced and refined. Medicare is also poorly structured to account for the complexities of chronic care and the increasing complex problems doctors manage in modern times.

The review is long overdue. Doctors are commonly heard to be lamenting the complexities, inaccuracies and redundancies in the MBS. It is important that this review becomes an important tool in modernising our medical system and maintaining a high level of care to patients. It is also important that this serves as a reminder of responsible use of the healthcare dollar; that is to say that we as a community spend an appropriate amount on procedures that are both safe and efficacious. I hope that review continues to be strongly influenced by clinicians, those with much more experience and knowledge than I have. Doctors are very happy to be a part of system that reflects the excellent health care that we can provide our patients.