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02 Jun 2017

AMSA's President Rob Thomas​ addressed the AMA's National Conference, highlighting mental health, student welfare, medical teaching and the working towards changing the culture of medicine. You can read a full transcript below and see the video here.


 

Before I start, I’d like to acknowledge the traditional custodians of the land on which we meet, the Wurundjeri people of the Kulin nation, and pay my respects to elders past, present and emerging. As we’ve already heard at this conference, this week is an important anniversary of the recognition of indigenous Australians, and equality in health for Aboriginal and Torres Strait Islander peoples continues to be one of our greatest goals, in collaboration with the Australian Indigenous Doctors’ Association.

 

As you heard my name is Rob, this is my very first national conference, and I have the great honour of representing more than 17,000 young people across now 21 medical schools around Australia. I sincerely thank the AMA again for having AMSA as part of this agenda-setting conference, and in their continued efforts to listen to and advocate for the future of the health profession.

 

When I left high school, I was determined to become a doctor as fast as possible. I had been accepted into the University of Queensland guaranteed postgraduate pathway, largely because the accelerated program would get me there quickly. I wanted to rush through my undergrad. It pained me to dedicate hours to the study of subjects I couldn’t relate to this vision of my future, always looking ahead to the clinical environment. My future was defined by medicine. I would be a doctor, work as a part of a team, and make people’s lives better by virtue of this fact. I found myself drawn to people who also happened to be headed towards medicine and whose aspirations matched mine. How little did we know...

 

Looking back, I should never have thought of the undergraduate period of my life as merely a delay to my journey into medicine. It was foundational, not only in content but also in life experience.  We are granted so many opportunities within medicine, but sometimes our overwhelming passion has the effect of doing just that - overwhelming us.

 

For myself, as well as many of my peers, medicine isn’t just about treating patients, but about helping people in the broadest sense - being an advocate, a champion for change, and this is an ambition that helps medical leadership to flourish. Earlier this week, I spent five days in Canberra with 100 ambitious, engaged, thoughtful medical students at our annual National Leadership Development Seminar. It reinforced what I love about AMSA - a unique organisation of young people with irrepressible enthusiasm. Together we spoke of how to address some of the largest health issues the world faces, like climate change, refugees, and the complex problems of mental health in medicine. Not only would we seek to cure our patients, but to fix the reasons that they are sick and the structures that perpetuate it.

 

Back in November, I read a popular article by an ED physician who received backlash for describing medicine as “just a job”. In it, he explained that his investment in medicine stopped when he left the hospital, allowing him the necessary time to restore and prevent his own burnout. While I’m not sure many would agree that medicine is “just a job”, he raised an interesting question around the ability for doctors to at times distance themselves from their all-encompassing careers.

 

I really admire his ability to step out of the role when his shift ends, and it’s certainly a protective skill that prevents us from taking every adverse event to heart. There are many reasons why treating medicine as ‘just a job’ seems like a great idea. Your ability to preserve an empathic approach to patients may be increased. Your relationships with family and friends may improve. You may be better able to cope with challenging patient experiences. When we strive for positive change and become a strong advocate for our patients, we inevitably take parts of their experiences with us.

 

In medicine, patients let each and every one of us into a privileged position in their lives. It’s incredible how many patients will open up about their lives, their fears and their hopes, and allow us into such an intimate situation. We are the ones who are there at some of the most vulnerable points in a person’s life. With this privilege comes responsibility, and it’s not without burden.  Every single person in this room is aware of the problem our profession faces with mental illness and it’s the reason that many AMSA presidents before me have chosen to speak to this issue as they gave this speech. According to the World Health Organisation, depression is now the leading cause of disability worldwide. This year, we’ve had tragic reminders of the struggles doctors experience and it’s not something I want our profession to be known for. I don’t have the answer, I don’t know what reasons there were for the suicides, but I know we need a change.

 

I sometimes wonder if medical students and junior doctors are setup to fail. Increasingly, the emphasis is on competition, it’s on being able to tackle the vast amount of medical knowledge that’s transforming every day. Although we talk about work-life balance, the system rewards us only for working harder. Like myself in undergrad, we’re always looking forward, always giving up time. We hear stories of fantastic individuals who seem to juggle it all, but for many this isn’t possible. Not only is absolute dedication idealised, it’s become a new frame of reference for young people trying to balance adulthood. While I recognise that pushing the boundaries leads to the advancement of medical knowledge, students need to learn how to do this safely.

 

Another issue that has permeated my experience at AMSA is the scope of an organisation such as ours. I’m surprised and encouraged by the diversity of my student cohort, not only in background but in opinions as well. However, these diverse opinions can lead to intense debate, which can be hard to grapple with at times. This issue is so prevalent that ‘scope’ has become a dirty word in our council discussion. Many, myself included, have been of the opinion that our primary focus should be on those issues that affect our education and our clinical practice. While these are and should remain important to us, there is a vast array of issues that influence health in an even broader sense. The Australian Medical Council Intern Outcome Statements has a whole domain on the intern as being an effective health advocate, recognising that our scope extends well beyond the hospital doors. In a world of post-truth, fake news and anti-vaxxers, I suspect the medical profession needs to embrace our standing as a source of expertise, and seek to expand our scope.

 

When we push for internships for all graduates of Australian medical schools, we are fighting for our future. But when we campaign for marriage equality, climate change legislation and refugee health we are not only advocating for ourselves, but also for our patients and more broadly, the world we live in. Advocating for these other issues says that we are more than just self-interested youth; and that this concern for others is central to who we are.  

 

Our generation are often told that we live in a world of incredible innovation and change. While innovations are often welcome, the relentless pace of economic change driven by technology is creating massive upheavals in the job market. Increasing casualisation of the workforce, job substitution, and other trends mean that our futures are more and more uncertain. This issue is extensively discussed by economists, and I don’t make any pretensions to be an expert in it. However, as young people on the cusp of our careers, these trends will affect us. They will also have a large effect on medical practice in general - ranging from young people not being able to afford private health insurance, to the question of whether some specialties will be around in 20 years time. This insecurity is something we’ll have to learn to be comfortable in.

 

To deal with these changes, resilience is needed now more than ever. Resilience isn’t merely being taught to “harden up”, it involves protective self care practice and should become a part of all levels of teaching. However, it’s only one step in fixing the problem - where the system may actually be at fault.

 

The effect doctors have on their students perhaps goes unnoticed day to day. Students model themselves on the people they see around them in the hospital. Beyond just medical knowledge, staff influence what we understand as normal professional practice. One example I think about it from my surgical term last year. I remember clearly my PHO coming in to the hospital early one morning, clearly unwell. I suspect it was influenza, but I don’t want to get it wrong in a room like this. I felt like saying “shouldn’t you go home”, but felt that I couldn’t suggest it to him. We proceeded with the morning round until one of the senior nurses turned up. Thankfully, she convinced him to go home, found a replacement for afternoon clinic, and that was that. Nevertheless his behaviour had an effect on me.

 

Medical students starting work on the wards work out what their place is by looking at those around them. Medical students are, by nature, diligent.  In order to feel less out of place, we emulate the doctors we aspire to be and take on their traits. This is true for both positive and negative behaviours, and is an important reason as to why culture is so hard to change. When you refuse to take a sick day despite obviously being unwell, we think it’s alright to do the same. When you neglect your family, or demand us to be there hours longer than our university designates, we absorb that too. A sponge has no filter – it absorbs everything.

 

Perhaps our seniors underestimate the depth of this influence. And the cycle continues when we ourselves forget that we are teachers too. Depending on how people work within them, hierarchies in medicine can be a tool for good; or perpetuate unhealthy cultures. When reasonable socratic questioning becomes teaching by humiliation, the power differential is exploited. Our concept of professionalism comes directly from our seniors - it’s not something that can be taught didactically. Every single medical professional has the power to change the culture of medicine, merely by looking to how you yourselves act. Much of this comes back to the concept of mentoring. It’s vital, and often accidental. In a lot of ways, I consider some of the greatest influences I’ve had as coming from those in the medical profession that show how they care. In my rural term, the influence and care I saw in my doctor’s practice was truly inspiring. It went beyond his clinical practice, and influenced the way I see doctors helping our community.

 

 

Not all of us are lucky enough to have such a humbling experience. In fact, the variation in clinical experience continues to be a concern for students. Some of us are bullied, some harassed, and, for some, ambition overwhelms the desire to care for patients. With the pace of change accelerating, doctors with a worldview that extends beyond the scope of clinical medicine are needed now more than ever. The AMA is the natural home for these doctors, and its work in facilitating student and junior doctor engagement is absolutely invaluable. I’d like to thank the AMA for its continued support of AMSA and the future of the medical profession. There are many challenges that face our profession and the health of our nation, and it gives me great hope to be a part of the organisation that addresses them.


Published: 02 Jun 2017