mind body miko https://mindbodymiko.com a health, fitness & lifestyle blog Sat, 07 Mar 2020 13:47:15 +0000 en-US hourly 1 https://wordpress.org/?v=5.4 152483466 Why doctors work when they’re sick #covid19 https://mindbodymiko.com/why-doctors-work-when-theyre-sick-covid19/ Sat, 07 Mar 2020 13:46:58 +0000 https://mindbodymiko.com/?p=1002 A doctor has been named and shamed in the media today. Victorian Health Minister Jenny Mikakos spoke about a GP in Melbourne who had tested positive for covid-19. She said she was ‘flabbergasted’ that he would continue to work, exposing 70 patients to the virus, and that his ‘irresponsible’ decision was something for the medical board (AHPRA) to pursue. There are so many things wrong here, and it has caused the medical community to respond with outrage. I’ve summarised some of the arguments:

Confidentiality

The doctor is now a patient with coronavirus. His right to privacy as a patient has been breached when details about him were released. His gender, approximate age, and workplace were revealed and it didn’t take long for the media to identify and name this GP, who happens to have a famous daughter. For him to be named and shamed is completely unfair, especially as he didn’t do anything wrong. His business is now threatened by this negative press.

The GP followed guidelines

This GP did not meet the criteria for testing. He had travelled to a country (USA) that was not considered high-risk at the time, and his only symptom was a runny nose which had mostly resolved by the time he went back to work. When he did get tested, which he chose to do for the sake of ‘completeness’ (as he has since come out to explain), he informed the relevant parties, stopped working, and his patients were notified and managed appropriately. If every doctor who had a runny nose didn’t go to work, the health system would collapse.

What it means for a doctor to call in sick

What this story highlighted for me was the fact that politicians are so out of touch with reality. I think Jenny Mikakos made a blunder today, but she is not a bad person. I met her last year when she supported a doctors’ mental health event (the launch for Crazy Socks 4 Docs), and I got the impression that she genuinely does care about doctors. What she perhaps doesn’t know is what it’s like on the front line. The public health system is already under-resourced and doctors don’t want to burden their peers.

Cultural factors

Doctors give each other grief (often behind their backs) when a colleague calls in sick. It’s one of the unfortunate things about the culture in healthcare. There is a lot of cynicism when a doctor calls in sick, especially if it’s a Friday or a Monday. People automatically assume that they’ve ‘chucked a sickie’ to enjoy a three-day weekend. Doctors become cynical because they are burnt out and the thought of having to cover for someone else when they’re already under the pump is overwhelming. Because of this, doctors are reluctant to call in sick. Discussions about this on Twitter were triggering for me. Dr Jill Tomlinson (@jilltomlinson) is a plastic surgeon in Melbourne and she recounts her experience of being sick when she was a registrar. Her supervisor had instructed her to take the Monday off, but she turned up knowing what other doctors are like.

The response she got from her bosses validated what she feared – that it’s not okay to take time off work. Reading her thread reminded me of my own experiences as a plastic surgery registrar. I was sick a few years ago during a long stint of being on call. The senior registrar had changed the roster and I was doing a lot of on call shifts. Another registrar and I would often screenshot our phone logs because we were astounded by the number of calls we would receive when on call (plastic surgery is a very high volume specialty). Surgical registrars have an unhealthy preoccupation with who gets ‘slammed’ the most. It’s almost a ‘survival of the fittest’ competition to see who can cope with the most demand. My eighth and ninth days during that particular stint looked like this:

I was absolutely exhausted and passed out on the Wednesday. None of my colleagues gave a damn. One of them came to get me at 1pm to make sure that I would come and help at the clinic. The next day, one of the senior surgeons came up to me in the operating theatre and asked if I was okay. I smiled, said I was fine, and continued on with the list.

Later that morning, he found me at a desk writing up an operation report, and he asked again, ‘are you sure you don’t want to talk?’. He had found out what had happened and was furious that the roster had been manipulated without consultant approval. He was concerned about my wellbeing and insisted that I take the next day off. Perhaps he could see that I was burning out. He even put it in writing, with this rather sweet emoji-filled email:

I didn’t know what to do. I was sick but I really didn’t want to take Friday off. I knew it was going to be a busy day with a consultant clinic. Unlike Jill, I decided I would rest, and I regretted it later. I got a cold response from my fellow registrars and bosses who were extremely unhappy about me not being there. I was devastated and I panicked about what the consultants would think of me. I confided in the head of unit, whom I had a good relationship with. He told me I had nothing to worry about. I had taken on the most burden that term, which was reflected in my operation numbers. But I did worry. I had thoughts like, what did I do? Why did I take a day off? They’re going to think I’m a slacker now.

These are the things that are happening every day in the health care system. No one wants to take a day off. Everyone wants to protect their reputation. In a job climate that is becoming more and more competitive, we can’t afford to take a day off and risk looking ‘weak’ or ‘lazy’. That’s the reality.

Medical workforce

And you know what makes it even harder to take a day off? The medical administration.

Dr Helen Schultz (@drHelenschultz) is a psychiatrist in Melbourne who won the Patrick Pritzwald-Stegmann Award at the Australian Medical Association (Victoria) Awards last year for her mental health advocacy. She runs a clinic for medical students and doctors, and knows very well the pressures young doctors face when they have to call in sick. You’d think a department called the medical ‘workforce’ might take responsibility for covering sick doctors, but no. Many hospitals make it the sick doctor’s responsibility to find another doctor to cover for them, which is incredibly hard to do. Most doctors are stressed and burnt out, so we don’t want to burden them even more by asking them to cover our shifts when we are sick. What it also means is that you have to pay that doctor back, so you may end up doing an extra shift on another week to make up for it – the thought of which is also very stressful.

Another excellent thread on Twitter is by Dr Sonia Fullerton (@sonialf), a Palliative Care Physician in Melbourne, who summarises the systemic factors that contribute to doctors working when sick. She also describes the scenario when a doctor does call in sick, and the havoc it wreaks. Another consideration is the fact that GPs are private contractors, which means that they do not have the same leave entitlements as doctors who work in the public health system.

Ramifications of naming and shaming

The GP who contracted covid-19 was named and shamed, which has ramifications not just for him, but for all doctors – summed up perfectly by this tweet from Dr Neela Janakiramanan (@NeelaJan), a plastic surgeon in Melbourne:

What has happened will undoubtedly affect business for this GP and his clinic. Moreover, the AHPRA threat also raises concerns. Being reported to the medical board is a life-changing (and sometimes even life-ending) event for doctors under investigation. It reminded me of the suicide of anaesthetist and intensivist Dr Richard Harding. His wife Dr Kate Harding bravely shared the story of her husband’s suicide in 2018. A complaint against Richard had been made to the General Medical Council, which led to a five-month investigation. Even though the matter was resolved in his favour, the impact of this complaint lasted far longer than the investigation, causing Richard to fall into a depression. He later took his own life.

Threats to report a doctor to AHPRA should not be made lightly. Doctors work so hard for their patients, and receiving a complaint is devastating. This news story has really made me sad today.

  • I want doctors to be more compassionate towards each other
  • You don’t know what’s going on in another person’s life. They may need time off due to a tragedy. They may be having a relapse of a chronic condition (physical or mental). They may be <it’s none of your f*cking business>. If a colleague takes a day off, be respectful. One day you may need to take a day off too
  • Doctors are not immune to illness. If a doctor becomes sick, they deserve the same confidentiality as any other patient
  • Shaming a doctor and threatening to report them to the medical board can destroy their career, and is detrimental to their mental health.

I am glad to see that the medical community is fully behind the GP in Melbourne. We support you. I hope you are recovering well from the illness and that you are able to return to work as soon as possible.

Lastly, as I was reading through the various discussions online, I realised that the tweets I shared were from women! It’s just after midnight, so it’s now aptly International Women’s Day. It’s wonderful to see such strong female voices on #MedTwitter. Shout out to the ladies I retweeted: @jilltomlinson, @drHelenschultz, @sonialf, and @NeelaJan. Check out their Twitter accounts for well-written threads on topical medical issues, and give them a follow!

Take care,

Miko xx

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Is having a ‘Plan B’ a bad idea? https://mindbodymiko.com/is-having-a-plan-b-a-bad-idea/ Sat, 29 Feb 2020 05:18:55 +0000 https://mindbodymiko.com/?p=990 Do you have a career Plan B, just in case things don’t work out? I’ve been thinking a lot of about the concept of a ‘Plan B’ in the context of careers, relationships, and just life in general. It’s certainly very topical at the moment, with changes to surgical training in Australia. In the past, you had unlimited attempts at applying for a surgical training program. The Australian Orthopaedic Association was the first to introduce a maximum limit of 3 attempts, with the other surgical specialties following suit. There are some candidates who will never get onto a surgical training program due to performance and other issues, but may never realise it because no one has the heart to tell them, or because they don’t know how to take the hint. In general, doctors are uncomfortable with giving negative feedback. I’ve experienced working with doctors who were told by their supervisors that they may wish to consider a non-clinical specialty (i.e. they are terrible with patients!) but kept pursuing a clinical career. The 3-attempt rule weeds those people out.

However, there are plenty of brilliant doctors who get onto training programs after more than three goes. It doesn’t necessarily mean that they are inferior to those who get accepted on their first go. We all know that selection processes are imperfect and not always based on merit. I worked with a registrar who was colour-blind and had a terrible tremor who was accepted into a surgical training program because he looked good on paper and knew who to impress. As hard as you might work to build a strong CV, obtain good references, and perform well in interviews, there are always elements at play that are outside of your control. With the maximum limit in place for most (if not all) surgical specialties from 2020, there is increasing pressure to have a plan B ‘just in case’ you use up your three tries.

… or maybe your Plan B isn’t even medical.

I’ve never liked the idea of a Plan B. It feels defeatist. I’ve always believed in willing things to happen, visualising success. By thinking of a Plan B, it tampers with that image… but thinking is not enough. A true plan B must already be in place, ready to take over, if and when Plan A comes crashing down. For example, if specialty B is your back-up, you need to prepare your application for specialty B by having experience, referees, and activities related to that specialty. With so many graduating doctors due to the medical student ‘tsunami’ of the last decade, the work environment is extremely competitive. Being good is not enough. I’ve met medical students who are already stressed about publications in their chosen field. It’s hard enough publishing papers in specialty A, you now need to be thinking about research in specialty B (and maybe even, C, D, and E) too.

What this creates is a dilution of your efforts. Plan Bs need investment, and that time, attention, and energy is taken away from pursuing your Plan A. Going to conferences, networking, and expressing interest all take time. Plan B is hard work. It’s a difficult dilemma and I won’t pretend that I know the answers. I do think that having a back plan or two can potentially sabotage your dream career. I believe in working your balls off and putting absolutely everything into your top choice, reflected in the ‘mamba mentality’ of the late LA Lakers star Kobe Bryant. When you don’t worry about a Plan B, you can exert all your energy and focus into what you really want. Having this winning mindset is something that is encouraged by many performance psychologists.

Putting all your eggs in one basket has a risk, of course. I’ve always been an optimist. I don’t like to think about failing. I like to deal with failure if and when it happens, but don’t let it invade my thoughts when I’m chasing a particular dream. By focussing on my plan A, I give it my undivided attention, and it allows me to be present. The criticism with this approach is that there is nothing in place if and when you fail, and it can make rebuilding a longer process. I’ve always told my students that if there are X number of spots for your dream job, you might as well get one of them. Why shouldn’t it be you? Go for it.

I feel the same way about relationships. How many of you have joked with a good friend, saying “Let’s get married if we’re both still single by <insert arbitrary age here>“? How many women have a male friend who will be their baby daddy / sperm donor if they haven’t found a partner by age 35 (and wants a child before the risk of Down syndrome starts going up)? I think most of us have thought about relationship back ups. The scary truth is, a lot of people do have back up partners, or “back burner” relationships, which sometimes translate to real life problems such as infidelity.

The underlying psychology is this: some people are afraid to be alone. Just in case the current relationship doesn’t work out, there is someone ready and waiting. Whether you call it ‘cushioning’, ‘benching’, or whatever the trendy dating lexicon is today, having someone as a back up can be harmful. At the very least, it’s selfish, and can be a cruel thing to do if the back up person has feelings for you.

In order to keep the back burner relationship viable, you have to maintain contact. With social media and mobile phones, this is increasingly easy to do. Whether it’s a sexy snapchat, a flirty text message, or a heart-eyes emoji on their latest selfie, people are easily accessible to keep communication channels open. This is at the very least emotional cheating, and stops you from being fully present in your main relationship. If you are keeping a back up person on stand-by, how can you be truly emotionally invested in a relationship? This causes people to sabotage their chances of developing a genuine and meaningful connection.

Another issue with having a back up partner is that it’s easy to turn to them when there are problems in the current relationship. Instead of addressing the issues and working on a relationship, it’s easy to seek support, comfort, or romantic attention from the back up without having to commit to the others aspects of being in a relationship. As such, the back up partner is seen through rose coloured glasses. The idea of that person is idealistic, and very rarely reflects what it would actually be like to be with that person.

So, I’m not a fan of the Plan B. Whether it’s a job, a partner, or anything else in life, I like to be present and mindful.

What’s your take on the Plan B? Is it sensible and realistic, or are you affecting your chances at giving your all to something?

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Book review: The Orange Grove by Kate Murdoch https://mindbodymiko.com/book-review-the-orange-grove-by-kate-murdoch/ Wed, 18 Dec 2019 09:19:11 +0000 https://mindbodymiko.com/?p=963 Disclosure: I was sent this book in September before it was due for publication. My apologies to Kate for not getting this review done sooner!

I could have read The Orange Grove in two sittings. In fact I did, except the sittings were a few months apart due to life getting in the way. As a Francophile, I was absolutely thrilled that Orange Grove was set in 18th century France. My favourite genre is historical fiction, and I’ve always had a soft spot for France, having studied French at school, visiting France in 2002 (including Versailles and OrlĂ©ans which feature in the book) and then again in 2014 for a hand surgery conference in Paris.

The setting is exquisitely described by Kate, who has clearly done an extensive amount of research to create a book that is authentic. Her descriptions of the fashions, interiors, and the grounds of the chateau are sumptuous. Moreover, one of the strengths of the book is the characterisation. Each person is believable that even the ‘villains’ are likeable.

‘Hell hath no fury like a woman scorned’ comes to mind when I think about the plot lines of The Orange Grove. Human nature never changes, which is what makes the story incredibly relatable. The book is packed with gripping, scandalous plot lines, which were complex and masterfully interwoven. Perhaps the parts of the book that were hard to read were the more sordid scenes. Some readers may be triggered by some of the content of this book – including infidelity, rape, child molestation, and violence.

Despite the tragedies, morality and the friendship between women prevail in what was ultimately a very satisfying and romantic ending to the book. It was a thoroughly enjoyable read, which Kate Murdoch has already been receiving accolades for, including short-list for the 2019 Chaucer Book Awards for pre-1750s Historical Fiction. Congratulations Kate! I look forward to Kate’s third book, The Glasshouse.

Happy reading,

Miko xx

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Book review: City of Girls by Elizabeth Gilbert https://mindbodymiko.com/book-review-city-of-girls-by-elizabeth-gilbert/ Wed, 28 Aug 2019 00:46:35 +0000 https://mindbodymiko.com/?p=932 Full disclosure: I won a copy of this book in a giveaway, so I didn’t buy it. However, I am not obliged to write a good review (or any review) so I will write exactly what I thought of it. I must admit, I watched Eat Pray Love at the movies and absolutely loved the story, and often reference it, but I have not read any of Elizabeth Gilbert’s books previously.

First thing: the book is long. If you’re after a quick read, this is not it. However, it is an easy one to read because Gilbert has an easy-going style, which I found really enjoyable. I personally love historical fiction so one of my favourite things about City of Girls is that it is set in the 40s. The vibrant descriptions of theatre life and show girls are just wonderful, and you can imagine every single character because they are all strong.

Vivian Morris is the main character, who writes the book as a reply to a letter she received, talking about her life as a twenty-something working backstage in costumery. The book probably could have been shorter. I particularly thought that chapters 26 – 29 (a “quick” what-happened-next about Vivian when she was older) weren’t really necessary, and it felt a bit laboured reading through them. However, it does lead to chapters 30 and 31, which were my favourite chapters of the book. It really is an expectedly heartwarming and satisfying conclusion.

If you’re already an Elizabeth Gilbert fan, you’ll love the fact that there’s so much of her writing to savour. However, if you’re a first time reader, it’s quite a thick book to get through. Regardless of that, Gilbert is a natural writer and the story was very enjoyable. I wouldn’t call it a “must read” but if you do pick this book up, you won’t be disappointed.

Happy reading,

Miko xx

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The plight of the Pre-SET registrar https://mindbodymiko.com/the-plight-of-the-pre-set-registrar/ Mon, 26 Aug 2019 02:14:21 +0000 https://mindbodymiko.com/?p=924 Happy Monday everyone. I’ve just returned from a weekend in Perth where I had the privilege of being part of the Western Australia (WA) Department of Health forum for Surgical Service Registrars, held at Fiona Stanley Hospital (image credit: Peter Bennetts). For the benefit of those who could not attend on the night, and for others around the country/world who are interested, I thought I’d share my presentation and the discussion points from the break out sessions.

The session was attended by the CEO of the Royal Australasian College of Surgeons (RACS) Mr John Biviano, members of the WA Health Medical Workforce, including Manager Ms Gillian Munyard and Medical Advisor Dr Paul Myhill, Chair of the Post-Graduate Medical Council Dr Marg Sturdy, consultant surgeons, including RACS (WA) Chair Dr Mary Theophilus, Prof David Fletcher, Dr Ian Gollow and Dr Stephanie Chetrit, and of course pre-SET registrars working in WA.

I’ll refer to Pre-SET registrars as ‘we’ even though I am no longer one. I choose to continue advocating for this space because I feel I would be a hypocrite not to. During my difficult term last year, I kept thinking to myself, “Why didn’t anyone before me say anything about this terrible term?” The answer is, they couldn’t. Therefore, now that I’m in a position where I can say something without fear of repercussion, I will.

I’ve deliberately used the term Pre-SET in this article. I remember an anaesthetist referring to me as the “Pre-SET” registrar and thinking to myself how nice that felt. It made me feel hopeful that I was on the way to becoming a SET registrar. Let’s discuss the title of “Unaccredited” or “Service” registrars. Words do matter. “Unaccredited” highlights the fact that we are not on training yet, which hits a sore spot. It can also make us feel inferior. “Service” Registrar implies that the registrar is there to serve, and only serve: a slave to the public hospital. This brings me to what I think Pre-SET registrars deserve:

  1. Supervision and education
  2. Wellbeing
  3. Safe working hours

Supervision and education

Governing body & representation

Pre-SET registrars are a voiceless and vulnerable population in the hospital system. We are waiting to get onto training programs, which relies on good references, therefore we are reluctant to say anything, as we do not want to be seen as a trouble-maker, struggler, or complainer. We do not have a governing body that is external to our hospital units that can administrate feedback about our terms.

Accredited registrars belong to the College. Interns and residents belong to a post-graduate medical council, which has various names around the country – e.g. PGME (WA), HETI (NSW), PMCV (Vic). Who represents Pre-SET registrars? No one. We had a discussion as to who would look after us. There was a divide at the forum – most seemed to feel that PGME would be appropriate, whilst others were concerned that there had previously been pushback from PGME. There was an impression that PGME was already overwhelmed with having to look after interns and residents. However this is a logistical and staffing issue, and the solution would be to have a dedicated team within PGME for the Pre-SET space.

In WA, there is a Service Surgical Registrar Employment Advisory Committee (SSREAC) which has existed for three years now. One issue identified was that this committee was not known to many of the registrars. It is therefore important for SSREAC to be more visible and engage directly with Pre-SET registrars. One motion from the forum was that a Pre-SET representative should be elected onto the committee. SSREAC is responsible for recruitment of Pre-SET registrars, and is currently trialling a feedback form.

Formal feedback

Feedback was identified as an important issue. This is bi-directional; registrars should be able to receive formal mid- and end-of-term feedback about their performance, as well as give feedback about the term. At the moment, registrars feel that they cannot give honest feedback about the term because if their criticisms can be traced back to them, it has a potential to affect referee reports. Thus, there needs to be an external governing body that can collate feedback forms and then anonymously present the feedback gathered over the year back to the units.

Whilst accredited trainees have an appointed Supervisor of Training who is responsible for completing compulsory mid- and end-of-term feedback forms, pre-SET registrars do not. It is hard to obtain feedback because most doctors find it difficult to give feedback, especially if there are any criticisms. For consultants to take feedback seriously, and give pre-SET registrars constructive criticism and a realistic view of their performance, feedback must be formalised.

The benefit of having a formal supervisor for a pre-SET registrar not only includes a means of receiving feedback, but also a point of contact for the registrar. Whilst we appreciate having a supportive consultant, that consultant cannot always advocate for us. In particular, if there is an issue between a pre-SET registrar and a consultant, it would be difficult for another consultant to stand up for the registrar against a consultant colleague without a formal role to facilitate a mediation.

Having a formal supervisor also means that there is a consultant with whom goals for the term can be identified and monitored throughout the term. One issue raised by the forum was that units do not have an introduction to the term. An introduction would serve to:

  • Identify the level of experience of each of the registrars, which helps to delegate tasks appropriately
  • Let registrars know what the expectation of the unit is (for example, doing a research project during the term, being able to do certain procedures by the end of term)
  • Allow registrars to voice what their expectations and learning goals for the term are, and how that may be achieved. This includes selection criteria for SET that they need to fulfil during the term.

The forum also acknowledged that a supervisor, assessor and mentor are three different roles, which should ideally be held by three different surgeons, which is not always possible.

Formal and informal education

It is in the interest of both the registrar and patients that we are given ongoing education and training. Formal, protected teaching can be difficult for pre-SET registrars to attend, as often we are the ones carrying the pager, however consultants at the forum acknowledged that informal teaching-on-the-run was important. One way to give pre-SET registrars an opportunity to learn in theatres is for a consultant to take the pre-SET registrar through a case that the accredited registrar is already familiar with, and has enough of in his/her logbook. By training pre-SET registrars, patients also benefit because they are being looked after by someone who is directly learning from consultants.

Wellbeing

How many doctors have to die before we take this seriously? Over-working and bullying doctors has a tremendous impact on doctors’ health and wellbeing. I briefly talked about the impact it has had on my health, even now, fourteen months after I resigned. We are all familiar with the bio-psycho-social model of health. We often focus on the biological aspects, but we don’t even get to look after basic needs like food and water. Sometimes we forget that doctors are humans and we deserve to be treated as such. As humans, we are multi-faceted and we have psychosocial needs too, which are often dismissed as being ‘soft’.

Does anyone remember playing The Sims?

Bio

  • Food
  • Water
  • Sleep
  • Hygiene
  • Exercise

Psycho

  • Free from bullying & harassment – is #OperateWithRespect working? Is it lip service, or will we see results?
  • Access to mental health services – Yes, all doctors should have GPs, but when do pre-SET registrars ever get time off to see one? What if we need psychology sessions? How do we fit that around a surgical on-call roster?
  • Reduced stigma about mental health
  • Being able to debrief with a mentor – it is the nature of our jobs that we are exposed to human tragedy, traumatic scenes, and we make mistakes that can leave us feeling guilty or scared.

Social

  • A life (!)
  • Quality time with family and friends
  • Relationships
  • Hobbies (what is that?)
Humans need fun, and we shouldn’t feel guilty for wanting to do something fun!

Doctors look after patients, yet we don’t look after ourselves. For us to look after ourselves, we need time to do so. Working unsafe hours not only means we are suffering from the effects of chronic stress and sleep deprivation, we don’t have any spare time to do things that are healthy for us. Therefore, an obvious solution is to make working hours and rostering fair and safe.

Looking after doctors’ mental health is receiving an increasing amount of attention. RACS has put in a tremendous amount of work into their #OperateWithRespect campaign, which is highly visible. However, it takes more than a campaign and a catchy hashtag to make change – it must be operational. I must say, it does anger me to see the hashtag misused. I want to see bullies caught out for their behaviours, but I am seeing it used for nit-picky and pedantic issues online. Just like any other political issue, political-correctness can sometimes become excessive to the point of absurdity. The power and impact of something gets diluted when it gets overused, to the point where now I am paying less attention to things tagged with #OperateWithRespect because it can be used for anything from sexual misconduct to the wording of a sentence.

Back to the actual campaign. Anecdotally, we have all seen surgeons who watch the compulsory video and don’t think that the scenario is an example of ‘bullying’. Others condemn the bullying in the video but then go on to exhibit bullying behaviours themselves. I understand that RACS is rolling out the new phase of #OperateWithRespect and will be re-surveying members of the College to see if there has been any noticeable change in the workplace culture. I look forward to seeing these results.

Safe working hours

A lot of work that we do is unrecorded or unrecognised. Most of us are happy to work overtime, but often feel that we are not valued. Rosters are often written by accredited registrars who take advantage of pre-SET registrars just because they can. It is the responsibility of both the approving consultant and medical administration to ensure that the roster being distributed is fair and safe. There are safe working hours guidelines published on both the AMA and RACS websites, but these are simply guidelines and hospitals don’t always follow them, because they are not enforced.

Another issue raised by the forum was the access to leave. It is difficult to ask for leave when SET registrars are prioritised for their study and conference leave. Some registrars commented that even getting time off for RACS courses such as EMST was very difficult.

Sleep disruptions during on call can be harmful to functioning the next day, and we are reliant on the goodwill of the consultant as to whether we are allowed to take a break or even go home. Sleep disruption is more harmful than short duration of sleep, and both are as dangerous as being drunk at work. Yet, sleep-deprivation is not taken as seriously as drug and alcohol consumption. To allow registrars to recover sufficiently from on-call, rostering should be reviewed regularly, and if possible, a back-up person available.

Workplace reform

Due to the response to doctor shortages, predominantly in rural areas, Australia has had a medical student tsunami which has had an impact on job numbers. There are several bottlenecks in the system – internship positions, progression to a pre-SET job, getting onto the training program, and even public appointments for consultants once training is over. There is a limit to how many accredited positions each unit can have for several reasons, including the dilution of case load if there are too many trainees. Whilst I recognise that existing accredited units cannot necessarily increase the number of accredited registrars they can train, I wondered whether the College could look into accrediting more units? Are there regional/rural or private hospitals that have the infrastructure, case load, and consultants willing to supervise and train registrars, that could become accredited units?

The idea of abolishing the Pre-SET registrar role altogether has been brought up previously. Is it time to revisit this? A lot can be learned from the US and UK models of post-graduate training. When a doctor is matched into a streamlined position after medical school, they are given a spot until the end of training, with all terms accredited towards their final fellowship. The UK’s parliamentary inquiry into medical workforce a decade ago – Modernising Medical Careers (MMC) – has produced a number of insights that we could learn from. A registrar at the forum recommended reading the documents on the MMC, which are freely available online here, here, and here. They are all quite lengthy, but there is also a short editorial by Delamothe in the BMJ “Modernising Medical Careers: A Final Report” BMJ 2008; 336; 54-5, which explains the model and its shortcomings (including the oversupply of applicants, which will also be an issue here).

Final thoughts

The WA forum offered a rare opportunity for pre-SET registrars to engage directly with consultants, government, and PGME in an open dialogue about the issues that we face. None of the issues are new. They have been known for a very long time, but it is great that they can surface openly rather than being swept under the proverbial rug. What I experienced last year was unfortunate, and whilst it was the hospital that gave a public apology, one of the surgeons there recognised that, really, the treatment I was subjected to was perpetrated by surgeons who are fellows of the College. I am not one to play the victim or hold grudges. I have moved on with my life to try and enjoy the new opportunities that I have been given, but it really means a lot to me when surgeons stick up for me like that – thank you.

Many thanks to Dr Mary Theophilus for advocating for Pre-SET registrars. Without her, this event would not have been conceived. Thank you to the Office of the Chief Medical Officer for putting on the event, and in particular Ms Gill Munyard for organising everything. Thank you to the registrars and consultants who attended. Without registrars who are willing to speak up about the issues, and consultants who are willing to listen and advocate at the higher levels, nothing will change for the next generation. I look forward to hearing the outcomes from this event, and I am interested to know what others think of the issues and possible solutions. Please feel free to add your comments to this blog post.

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Book review: The Erratics by Vicki Laveau-Harvie https://mindbodymiko.com/book-review-the-erratics-by-vicki-laveau-harvie/ Tue, 13 Aug 2019 03:28:29 +0000 https://mindbodymiko.com/?p=920 The Erratics is the 2019 winner of the Stella Prize, which celebrates female writers in Australia. There’s an interesting story to the lead up to that moment. The book had actually gone out of print after the original publisher folded, but it was since picked up by Harper Collins for re-publication.

Vicki Laveau-Harvie is a debut novelist, and The Erratics is a memoir of a difficult time in her life, coping with the demise of her elderly parents who she had gotten estranged from. The striking thing about the book, almost immediately, is her unique voice. It reads like poetry. Something rhythmic, like a haiku.

The bleak and harsh winter of Canada is the backdrop, described beautifully by Laveau-Harvie, which complements the cruelty with which her mother treats her father. Although a diagnosis is never mentioned, it is clear that her mother suffers from severe psychiatric illness – almost certainly a personality disorder, and possibly a concurrent mood disorder. The book delves into the devastating impact that psychiatric illness has on families, but it is written with a distance. It is almost unemotional. Laveau-Harvie does have a good sense of humour about her, which is dark and dry. I did catch myself having a little chuckle to myself at times, despite the intense tragedy of the book.

The glaringly missing thing from this memoir is any reference to childhood. Most children with abusive parents have complex trauma that affects them well into adulthood, which would have been an important piece for this memoir. The ending is also somewhat unsatisfying. However, the beauty of the book is really in the writing rather than the plot. It can be at times repetitive – her mother’s broken hip being referred to as “powder” one too many times – and the modern pop-culture references are a bit cringe-y, but there is no denying that Laveau-Harvie is a gifted and experienced writer. Her metaphors are original and delicate. This piece of narrative non-fiction is truly art.

Happy reading,

Miko xx

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Magnesium and sleep https://mindbodymiko.com/magnesium-and-sleep/ Fri, 02 Aug 2019 08:37:55 +0000 https://mindbodymiko.com/?p=912 Magnesium is an essential mineral that has many physiological functions in the body such as bone health, muscle health (including cardiac muscle), mood, and sleep. Most people have used Epsom salts after a hard workout to relieve muscle soreness, but magnesium is less known for its beneficial effects on sleep.

Magnesium works to increase the levels of a neurotransmitter called gamma amino butyric acid (GABA), which is responsible for calming down the nerves to our muscles, thereby helping us relax. Magnesium also directly binds to GABA receptors.

There are several ways that we can increase our magnesium levels. Green leafy vegetables, nuts and seeds are high in magnesium. There are also supplements. The highest concentration of magnesium in a tablet that I am aware of, is BioMag, which I prescribed a lot as a junior doctor for patients requiring oral supplementation.

More recently, direct absorption through the skin has been popular for muscle relaxation. In the photo below is the Base Collective Magnesium & Lavender soap on the left, which has a lovely lavender smell (which is also beneficial for sleep). The product is also vegan friendly and cruelty free. The ‘Beauty Sleep’ range from Base Collective also features a spray and a balm.

In the centre is my favourite magnesium oil, the Magnesium Plus oil by Bare by Bauer. It is also vegan friendly and cruelty free. Best of all, there are no nasties – the whole formulation is made from natural essential oils (including, you guessed it, lavender!) and coconut oil as its carrier oil. The smell is truly luxurious – I love it! I use it on any sore muscles, and particularly on my neck and shoulders before I go to bed.

I’ve also been consuming Third Wave Nutrition’s PlantForce Magnesium, to the right of the photo. This product is vegan, and has a mild citrus taste. It has become my bedtime drink! It effervesces and dissolves quickly with warm water and then I top it up with room temperature tap water. I definitely feel more relaxed after drinking this, and I’ve made it part of my bedtime routine.

All three products are Australian, which is something important to me. I try my best to support local as much as possible!

Lastly, having a night routine is so important for sleep. It’s part of having good sleep hygiene – do have a read of this blog post I wrote if you haven’t yet. It has all my tips on getting a good rest. It’s sometimes hard to do everything, but maybe incorporating one or two things to start with may help. Since writing that post, I have also benefited so much from weighted blankets, which I’ve also reviewed. I do suffer from sleep problems, but doing a combination of all of these things really does have an added effect!

As I described in my sleep hygiene post, I like to light a lavender candle 30 minutes before bed so that my whole room is filled with the lovely, calming smell. I use lavender soap for my shower, and if I’m washing my hair I have calming shampoo and conditioner (I shall have to write another post on more sleep products I’ve been testing lately). Then, I read on my couch (not in bed!) until I feel sleepy, have my PlantForce Magnesium drink, rub on some magnesium oil, and off to bed I go under my weight blanket. Seems like a lot of things, but once you add one thing at a time to your routine, you go into auto-pilot.

Sweet dreams,

Miko xx

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Book review: Slice Girls by Joan Arakkal https://mindbodymiko.com/book-review-slice-girls-by-joan-arakkal/ Tue, 16 Jul 2019 02:47:34 +0000 https://mindbodymiko.com/?p=894 I really, really wanted to love this memoir. Slice Girls is written by Dr Joan Arakkal, who writes about her experiences in the male-dominated field of Orthopaedic Surgery, where only 4% of surgeons are female. She grew up in India but has worked in the UK and now resides in Perth, Australia.

I still remember the day I found this book. I had walked into Better Read Than Dead in Newtown, a book store that my friend Karen had recommended. As I always do, I started from the front of the store and worked my way systematically towards the back. As someone who has worked in retail in the past, I always have a keen eye for visual merchandising. I like to look at how the books are arranged, and study which covers grab my eye first. I start with the central table of books to see what the current bestsellers are, and then trace the shelves that line the sides of the shop. I stop at every book that has a white tab and read the recommendation written by one of the booksellers. I take a mental note of which books I want to add to my reading list.

I ask one of the store staff to show me where I would find the memoirs. I generally read fiction, but I’ve taken an interest in memoirs after reading the marvellous memoir by Magda Szubanski earlier this year. I scale the shelf up and down, side to side, and my eye falls on a book in the top left corner. It is green and pink, a colour combination I appreciate, but importantly, it is an image of a surgeon with wordplay in the title referring to the Spice Girls. Sylvia the lovely bookseller climbs a step ladder and grabs a copy for me, and I immediately decided that that was the book I wanted to purchase that day.

I’ll start with the cover. My hawk eyes don’t miss a thing. Whilst I enjoyed the colours, I noticed a few things that got me questioning. Why is the person on the cover not wearing theatre attire? The gown that is being worn is a light, unsterile gown that is worn for contact precautions. The scalpel has a plastic blue handle – one that we use for minor, non-sterile procedures on the ward and in the Emergency Department. The glove that holds the disposable scalpel is loose-fitting and slips underneath the gown, rather than over it. Hold on. This is a memoir about surgery. Where are the surgical scrubs and metal scalpel? Is this a deliberate or ironic choice?

I put aside my dissatisfaction with the cover image and read the notable endorsement on the cover by Dr Barry Marshall, Nobel Prize winner for his groundbreaking work on Helicobacter pylori; ‘Uplifting and very readable’. Great. Exactly what I want out of this memoir – an inspirational story of a woman who rises against the odds. I turn the cover and start reading. Arakkal quotes the Pavamana Mantra, one of my favourites in the Upanishads. I sing along to it in my head and feel the peace of the melody.

I keep reading the book and start to find it uncomfortable. Come on, I’m supposed to like this book. Sisterhood. Women in Surgery. Otters. #ILookLikeASurgeon. I want to support this writer, I want to like her. That’s the thing about writing a memoir – it’s deeply personal and you put yourself out there for people to judge. The early chapters of Arakkal in India glaringly reveal how privileged and relatively easy life was for her, being one of the ‘forward’ groups in society that were advantaged by ‘positive discrimination’. I kept reading about Arakkal’s achievements which are written with feigned modesty. It is only later in the book that Arakkal acknowledges her privilege.

I am by no means a professional book critic. I’m just someone who has a love and appreciation for languages and literature. From that point of view, I found the style of the book a little confusing. In parts it reads like narrative non-fiction, and in others it is an Op-Ed by someone with a bone to pick (#sorrynotsorry for the pun). There are some truly wonderful passages that describe a beautiful sari at an Indian wedding, the splendid flora we have in Australia, and this:

The smell of sardines fried in coconut oil, the hot unpolished rice, the early morning aroma of puttu – layered rice flour and grated coconut pushed out of its long cylindrical steamer – the tropical vegetables and heady fruits – all played havoc with my taste buds

There is no doubt that Arakkal is an intelligent woman. Her writing is so intellectual, however, that sometimes I’m begging to know how she’s feeling about certain scenarios that allow us to get to know her better. For example, meeting and getting married to her husband is over and done with in one and a half short paragraphs. She also describes her experience with metastatic breast cancer in an unemotional, matter-of-fact way. Indeed, the book travels at a fast pace, and the writing often choppy and jumpy. Towards the end when she writes fervently about her issues with the Orthopaedic community in Australia, she comes across as bitter, cynical, and defeated. There were more than a few times that I noticed repetition (almost word for word) of her arguments, which felt like I was listening to a debate.

Despite the obvious chip on her shoulder, Arakkal does highlight some very important issues for the medical profession in Australia to consider. I had great sympathy for her when she shared anecdotes of racism and sexism, which are still sadly commonplace. Arakkal has had to tolerate so much bullying and discrimination since coming to Australia, which I can relate to. She also observes bigoted attitudes towards Indigenous patients.

Arakkal has a strong feminist voice, which genuinely encourages women to lift each other up. I think that this surgical sisterhood is so important, and one that has also kept me buoyant during difficult times.

Slice Girls also explores the hostility one faces when coming to Australia as an International Medical Graduate. Even though she passed her fellowship exams in the UK, she was required to sit the AMC exams, which tests medical knowledge that most of us have left behind in medical school, or once we decided upon a specialty to pursue. She also found herself having to work as a service registrar, which I can only imagine is a rough gig for someone who had worked in more senior positions overseas.

There were times when I gasped at the politically incorrectness of the book, including the assertion that someone ‘eccentric’ would be suitable for Psychiatry. I wish that people would not paint entire specialties with one stroke. She is also scathing of Orthopaedic surgeons, which I do not think supports her cause:

The principle ‘Primum non nocere’ – ‘First do no harm’ – is often overlooked. After all, Hippocrates didn’t have a new Porsche to pay off.

Lastly, I really hoped for a happy ending, but I did not find the ‘uplifting’ effect that Dr Marshall described. Arakkal has still not been accepted into Orthopaedics, and is working in occupational health. I so wanted to read about how she had overcome obstacles to practise her beloved sub-specialty of hand surgery – an area of surgery I can totally relate to having a passion for – but alas, that was not to be. This is why I took a couple of days to write this review. I had such mixed feelings during and after reading this book. I really hope that Arakkal has found some solace in writing this memoir.

I am onto my next book, which is also a memoir – The Erratics by Vicki Laveau-Harvie, which won the 2018 Finch Memoir Prize and 2019 Stella Prize (an award for women writers in Australia). Please look out for my review later this week.

Happy reading,

Miko xx

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Book Review: The Nancys by R.W.R McDonald https://mindbodymiko.com/book-review-the-nancys-by-r-w-r-mcdonald/ Sat, 13 Jul 2019 08:50:56 +0000 https://mindbodymiko.com/?p=888 I love love loved this debut novel by R.W.R McDonald! I won’t lie, the first reason I picked up the book was because I saw the cover and the pop art spoke to me. I totally judge a book by its cover. I can’t say I’ve read a lot of crime fiction so this isn’t normally a book I might have discovered organically, but it’s hard to miss this one – it is featured everywhere at the moment, including many of the top 10 bestsellers at indie bookshops. I also have a soft spot for my gays. I honestly don’t know how I would’ve gone through some of life’s tough moments without my gay best friends, so when I read that the book was about a young girl, her uncle, and his boyfriend’s adventures solving a crime, it got me interested.

I have to say that the strength of the book is in its characters, who were all believable and created with such fine attention to detail. Tippy Chan is the sweet protagonist who shows bravery and maturity for a young girl who is processing the grief of losing her father whilst embarking on a crime investigation involving a murder in her small town. You cannot help but want to support Tippy and give her a hug. There are also subtle hints throughout the book that Tippy is unsure about how she feels about boys and girls; that she is beginning to think about her sexuality. This is in the setting of having an openly gay uncle Pike, and his hilarious boyfriend Devon, who supplies the comic relief in the book. There were definitely some laugh-out-loud moments provided by Devon, who was easily my favourite character.

I read The Nancys in two and a half sittings. It was easy to read, brilliantly written, and ultimately heart-warming. The love of family and friends is a powerful theme in the book and it made me wish I had an uncle like Pike. Even the less likeable characters have aspects to them that endear them to us. The story was very cleverly constructed, some moments of great suspense, and I was sad when the book ended. I want to know more about the people in the book – like watch Tippy grow up, and hear more of Devon’s cheeky and affectionate banter with Pike.

The Nancys was such a satisfying read. I think my favourite book of 2019 so far! I really hope to see a sequel to The Nancys (perhaps there will even be a whole series just like Nancy Drew, which this book was inspired by). If it’s not already on your #TBR pile, it ought to be!

All pink errythang!!! Loved this book so much!

Happy reading,

Miko xx

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Book review: Everything I Know About Love https://mindbodymiko.com/book-review-everything-i-know-about-love/ Tue, 09 Jul 2019 04:55:43 +0000 https://mindbodymiko.com/?p=875 I must admit, I bought this book in November last year and didn’t get too far. I remember receiving an email from the Book Depository promoting some of its best-sellers, and found this book amongst them. Having not lived in the UK since 2002, I wasn’t familiar with Dolly Alderton’s dating column or podcast, but the title did catch my eye.

The past month or so hasn’t been exactly easy for me, so I just wanted to read a light-hearted book, and this book was perfect for that. It is a memoir of Dolly Alderton’s dating life, which is full of ridiculous stories in the early years. The first half of the book is a little contrived, I must say… it feels like Alderton is trying way too hard to be funny. However, she begins to write more honestly in the second half of the book, revealing discussions she has had with her therapist, and other personal reflections. I felt that this was where her writing really shone.

Initially, I didn’t think I could relate to the book, but when Alderton dissects her past and comes to an understanding about why she had been unfortunate in love, her truths uncomfortably resonated with me. Each person has a different psychology when it comes to love. Some are serial monogamists, who don’t know how to be alone, whilst others have never had any long-term relationships. The reasons are plentifold and everyone has past experiences that shape the way they conduct their relationships. After reading the book, I decided that I was definitely a ‘Dolly’.

The most powerful part of this book is definitely the friendship between Alderton and her best friend Farly. It reminded me of how much I appreciate my closest friends. It truly is a beautiful ‘girl power’ moment when she speaks so endearingly about her closest girl friends at the end of the book. As soon as I finished reading it, I texted my bestie and told her I’m lending her this book!

If you’re looking for a (mostly) light-hearted book with a feel good ending, I would recommend this!

Happy reading,

Miko xx

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