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The Universal Doctor Doctors writing about humanity and resilience in medicine What is your story? Compiled by Leanne Rowe and Michael Kidd Rowe L, Kidd M ISBN: 978-0-9945450-0-8 What is your story? The Universal Doctor is presented an example of the power of doctors’ stories. We are seeking more stories from family doctors from around the world to contribute to a new edition on humanity, human rights and resilience. Please send your piece of writing (no more than 2000 words) to us for consideration for volume two to: [email protected]. Please also join ‘The Reading Room’ to share other great books and promote the title of your own book to https://www.thereadingroom.com/Leanne%20Rowe. Dedicated to the 500,000 family doctors from 150 countries who, as individuals and as members of medical colleges and societies, come together as the membership of the World Organisation of Family Doctors (WONCA). Published by the World Organisation of Family Doctors 2016. Copyright of the stories and poems is held by the authors. The World Organisation of Family Doctors and the authors also gratefully acknowledge the work of: Dr Karen Flegg for formatting Dr Peter Jasek for his cover photo of Gertrude Saddle, NZ Patient cases have been changed and de-identified to protect privacy. 2 The Universal Doctor The Universal Doctor Doctors writing about humanity and resilience in medicine 3 Rowe L, Kidd M Contents Chapter 1 - Why write about resilience and humanity in medicine? ............................... 6 1.1 What kind of doctor do you want to be? - Adj Assoc Prof Leanne Rowe ................. 7 1.2 My greatest teachers - Prof Michael Kidd ................................................................. 9 Chapter 2 - Seek inspiration and support from mentors and role models .................... 11 2.1 Loneliness - Prof Edward Byrne .............................................................................. 12 2.2 The importance of personal involvement - Dr Donald Cordner ............................. 13 2.3 A view from the other side - Prof Chris Silagy ......................................................... 15 2.4 On openness, humour and loyalty - Prof John Murtagh ......................................... 19 Chapter 3 - Debrief often about loss and death .............................................................. 21 3.1 Meditation - Prof Edward Byrne ............................................................................. 22 3.2 Death and the comedian - Dr Peter Goldsworthy .................................................. 23 3.3 Witnessing death - Dr Hilton Koppe ........................................................................ 29 3.4 Wilful forgetfulness - Dr Ranjana Srivastava ........................................................... 31 Chapter 4 - Focus on the quality of patient care ............................................................. 33 4.1 The last resort - Dr Karen Hitchcock ....................................................................... 34 4.2 The humanitarian art of doing nothing - Dr Justin Coleman .................................. 42 4.3 On healing - Prof Helen Milroy ................................................................................ 65 Chapter 5 - Advocate against disadvantage .................................................................... 58 5.1 On the edge - Dr Bill Bateman ................................................................................. 59 5.2 The criminalization of acute psychosis - Adj Assoc Prof Leanne Rowe ................... 61 5.3 Aboriginal child suicide - Dr Howard Goldenberg .................................................. 63 5.4 Stranger Welcome - Prof Amanda Howe ................................................................ 57 4 The Universal Doctor Chapter 6 - Remain curious about humanity .................................................................. 66 6.1 On difficult times - Prof Edward Byrne ................................................................... 67 6.2 The man who cut his hands - Dr Howard Goldenberg ............................................ 68 6.3 The blurring of work and life boundaries - Adj Assoc Prof Leanne Rowe ............... 70 6.4 On curiosity - Dr Faith Fitzgerald ............................................................................ 71 Helpful books: .................................................................................................................. 78 Helpful websites: .............................................................................................................. 78 Biographies of authors ..................................................................................................... 79 5 Rowe L, Kidd M Chapter 1 Why write about resilience and humanity in medicine? ‗I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug…I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick… Hippocratic Oath: Modern Version—Written in 1964 by Louis Lasagna, Academic Dean of the School of Medicine at Tufts University 6 The Universal Doctor 1.1 What kind of doctor do you want to be? Adjunct Associate Professor Leanne Rowe 2009 was a very significant year. Professor Michael Kidd and I published a book ‗First Do No Harm: Being a Resilient Doctor in the 21st Century‘, and my young husband, also a GP was diagnosed with an aggressive prostate cancer. Since that time, throughout my husband‘s seven year cancer journey back to health, I have been exposed to the best and the worst of the medical profession while sitting quietly on the sidelines of over one hundred consultations. So far, we have consulted many dedicated treating doctors, including generalists and subspecialists, most of whom we are indebted to. In the early stages, the generosity of some doctors was outstanding, including one notable Professor of General Practice, who volunteered to do a locum for our rural general practice, unphased by the three hour return drive to his home. In contrast, I have also witnessed the cold and arrogant side of many other doctors, who seemed oblivious to the damaging impact of their poor communication skills, particularly when my husband‘s prognosis was fragile. There were many occasions when like Professor Faith Fitzgerald in her story on page 71, I questioned why idealistic and optimistic medical students sometimes turn into ‗insensitive, mechanistic, technocratic, or inhumane brutes‘. I also identified with Dr Peter Goldsworthy‘s reflections on page 23: ‗Medicine, like any work which involves contact with a lot of human misery - and human stupidity - tends to shrivel the heart‘. The cold lack of humanity and empathy from some colleagues was very painful. In parallel with this unfolding personal battle, I was involved in developing ‗The 2013 beyondblue National Mental Health Survey of Doctors and Medical Students‘, which documented high levels of psychological distress (13.4%), suicidal ideation and self- medication in a sample of over 14000 Australian doctors and doctors in training. Certain groups were more affected than others – for example, female doctors were found to have a suicide rate 2.5 times that of women in the general population, with a very high 20% of female doctors reporting suicidal ideation in the previous 12 months. Overseas trained and Indigenous doctors were more likely to report being very stressed by racism and bullying, at the hands of both colleagues and patients. All of these significant issues must impact on the ability of doctors to care for their patients, and yet, one of the most striking responses to the release of the beyondblue study was the silence and inaction from the medical profession. Our book ‗First do no Harm‘ had been well received by some, but others did not see the need to talk about resilience, depression or suicide in our profession. 7 Rowe L, Kidd M All these experiences led Michael and I towards a deeper search for resilience and humanity in medicine. We asked some inspirational doctors how they transcend adversity and continue to care for their patients, their families and their own spiritual, mental and physical health in times of immense stress. And this book of their stories emerged after we discovered that many of them use writing as a powerful outlet for the inevitable pressures at work. While the doctors‘ pieces of writing are brutally honest, poignant, diverse, and as funny as they are tragic, a number of themes about resilience emerged, which have formed the sections of this book on: Seek inspiration and support from mentors and role models Debrief often about loss and death Focus on the quality of patient care Advocate against disadvantage Remain curious about humanity. The optimistic messages in each chapter are for doctors at all stages of their careers, and everyone else involved in the health system - nursing and allied health professionals, medical practice and hospital staff and their patients and families - because the search for resilience and humanity is shared by us all. And for me, after reading this book of doctors‘ stories, I now have a very clear picture of the kind of doctor that I strive to be – and this is beautifully expressed in a piece by Anatole Broyard, editor of The New York Times

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