Panacea Volume 49 Issue 2

In this Edition

Balance?

By Ming Yong, AMSA Publications and Promotions Officer 2015 and Panacea Editor-in-Chief

PART 1: WORK Work hard, play harder - there is another way It’s elemental Staying healthy: FAQs 75 Years of Trephine Videoconferencing: the future of medical education?

Doctor on call: the future of medicine and healthcare Thriving versus only just surviving medical school

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When I set out to put this edition of Panacea together, I first thought of a theme. Like our previous edition, I sought to make it as interesting as possible - perhaps, like the last one, a theme that would draw people to write about their lives, the conventional and unconventional things they do - and a theme that is broad, all encompassing, and of course, open for interpretation. Secretly, I wanted to replicate what I did with Panacea 1: to have this collection of stories of amazing people who do amazing things with their lives, from champions on the sports field, to victors of the textbooks.

Fortunately, this was not the case.

Instead, I ended up with a collection of personal stories from your everyday medical student. Don’t get me wrong, they are all amazing, but unlike Panacea 1 which featured amazing people that I hoped would inspire readers to pursue the unconventional, the collection of stories that were submitted to Panacea 2 were more, for lack of better terms, relatable.

PART 2: PLAY The day off, or Frogging Exercising mind and body?

I can’t help but run from my problems Sports and social around the country: a collection of reports Hacking to health Play: The Antidote Remaining in the moment

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By James Lawler, AMSA President 2015

A statement which is often put to me as President of AMSA is “You must be busy”.

PART 3: BALANCE Work/Play balance: the perspective of one who fell off the scales

You must be busy

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PANACEA VOLUE 49 EDITION 2, OCTOBER 2015 To advertise with AMSA, contact sponsorship@amsa.org. au. For any enquiries about this publication, please contact ppo@amsa.org.au Printed by Printnova, Newcastle NSW This edition of panacea, again, is dedicated to all Twenty 2015 AMSA Representatives. It has been such an amazing experience working with each one of you throughout 2015.

It’s a rhetorical question in a sense; it invites me to complain about a tiring travel schedule, lots of emails or a bunch of meetings. The invitation is often tempting – I do travel a lot, I receive a great deal of emails and I’m the head of a group of 150-200 volunteers.

When I first started medicine, I was much busier. Hit with a full-time study load, a raging social life and a desire to get involved with a range of extra-curricular activities, there was no time for a breath. Being busy is fun, and can make you feel important – it can be part of your sense of self.

But like most people who are “busy”, I wasn’t always enjoying

A majority of us start medical school, wide-eyed, simpleminded and goal-oriented to be the best medical student, and in the process, to study as hard as we can and to achieve the best results we can hope for. In the process, however, we often lose sight of a life outside medicine, where friends, sunshine and fun awaits. Why is that? And why is this the case for so many of us?

I remember back when I was in my earlier days of medical school - I used to think work/life balance was an elusive thing and you can’t be good at both but rather, one or the other. Having navigated life through medical school, extracurricular activities like MedSoc and AMSA, friends, exercise and keeping up with my hobbies, I can assure you, work/life balance is not an illusion, rather it is a secret skill that everyone has, waiting to be understood.

very different things complement each other and bring out the best of both worlds and at the end of the day, what makes me a better and more well-rounded person.

This is my take on work/life balance. It is just one opinion on the matter and within these pages are, as I’ve said, a whole lot more of personal stories and experiences on the matter! So please enjoy yourselves and have a good read. Above all, I hope that once you have finished reading through the pages of this Panacea, you will feel inspired to explore what work/ play balance means to you and if you haven’t already, how you can achieve this!

- Ming

People often ask me why I do so much work outside medicine and how I keep up with all this AMSA business on top of a full clinical workload. My response is simple: while providing a nice escape from the mundane life of tutorials and ward rounds, being busy outside medicine also makes me aware of how much time in a day I have, and with this awareness of time, it makes me a more efficient and effective medical student. All in all, play helps me become a better worker, and work makes me play harder.

To me, that is work/life balance. A Yin and Yang where two

myself. Being forced to do work which I’d signed up for, waiting around at University for yet another social event – I was feeling tired and drained by this experience.

There’s a real danger to this mindset. If you let yourself believe that being “busy” is part of being a medical student, or even worse, your identity, then you’ll lose the battle. You won’t have time to enjoy life – catch up with friends, speak to family, exercise, read, listen to music. But just as importantly, you won’t be able to take advantage of the next great opportunity which comes along.

Everyone has probably used this phrase at one point in their lives: “I’d love to, but I’m too busy”. There are probably then two types of people: Those who don’t mean it, and those who do. I often wonder about those who truly believe that they are too busy to do something they really want to do and shake my head.

Life is about choices. If I was too busy studying medicine to do something I’d rather do than medicine, then you would have to deduce that I should quit medicine. It’s a choice to study medicine, not something which anyone has forced me to do.

Just as it’s a choice to go and exercise, to eat a good diet or to catch up with a good mate.

My year as AMSA President has been amazing, and I’ve loved it, but I refuse to believe that I’ve been busy. I’ve had to make

sure that I’ve found time to read books and call home while I’ve travelled. I’ve had to figure out efficient ways to deal with emails, and I’ve learned that by delegating to people, I can be more effective and so can AMSA. I open this edition on “work-life balance” in Panacea because the phrase is often misrepresented as laziness or a lack of ambition. In fact, it is just the opposite. Because even without medicine, or AMSA, I first and foremost need my family, my friends, my health, my intellect and my identity. Work-life balance is about taking a step back to look at the bigger picture and seeing what is most important.

- James

THE AUSTRALIAN MEDICAL STUDENTS’ ASSOCIATION: What we’re all about The Australian Medical Students’ Association (AMSA) is the peak representative body for medical students in Australia. Each of the 20 medical schools in Australia elects a representative to sit on AMSA Council, which is the primary decision-making body of the Association.

The key mandate of AMSA is to connect, inform and represent Australia’s 17,000 medical students. AMSA’s core operations are aimed at realising this mandate.

These operations include: Advocacy – AMSA advocates for medical students through policy development, advocacy campaigns and representation to governments, universities and relevant medical and medico-political bodies. AMSA has a strong grass-roots approach to policy development whereby AMSA Subcommittees produce and review policy and other initiatives. These are chaired by local AMSA Representatives at medical schools throughout the country.

Events, programs and projects – Medical students from across the country are able to connect with peers by participating in AMSA’s renowned educational, social and leadership events and programs. AMSA runs projects across several different areas including those designed to improve medical student health and wellbeing and others for community participation.

Global, rural and Indigenous health – Global health, rural health and Aboriginal and Torres Strait Islander health are important focus areas for AMSA and its members. AMSA provides specific opportunities for medical students to become actively involved in these areas while still studying, for example through AMSA’s popular AMSA Global Health committee.

Publications – AMSA produces many publications which are distributed electronically and in physical copies. These publications are an important conduit through which AMSA connects and informs Australian medical students.

The AMA Careers Advisory Service is your one-stop shop for expert advice, support and guidance to help navigate your medical career.

Interview practice, CV reviews, application guidance, junior doctor employment guides – we have all the top tips and tools to give you the competitive edge to reach your career goals.

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Š U.S. National Archives and Records Administration

WORK Panacea 7

Work hard, play harder – there is another way

By Dr Anne Malatt

PART 1 The culture of medicine asks us to work hard (even demands it of us), and encourages us to play even harder.

What are our definitions of work and play; that it needs to be this way, and is there another way to live?

Work The definition of work has many nuances, and the way we view work is vital to our health. Do we see it as a drudge, a chore, a stress, a necessity, an evil?

Or do we see it as a calling, a vocation, a pleasure, even a joy?

If the way we work makes us feel stressed, tense, drained, exhausted, and depressed, we are going to need to seek relief and release from it.

If we love it, we can do it all day, and end the day tired, but happy, and ready for relaxation, rest and bed.

Partying has side effects (or as I like to call them, effects).

Alcohol is a poison, with effects that we all know (or should) by heart. Even if we missed that one lecture on alcohol addiction during our medical training – as I did, because I was in the pub – we feel these effects in our bodies every time we drink and every time we wake up with a hangover.

So why do we continue to drink and these days, increasingly, to take other drugs?

Why are we, some of the most intelligent people in our society, making choices at the great expense of our bodies – bodies which we spend years learning about, so we can take care of other people’s? And most ironically, why are we choosing to ingest a neurotoxin, a poison for our minds, which we value so highly?

What is it about our training that condones this? What is it about the system that asks us to work hard and encourages us to party harder?

And what is it about us, that goes along with the idea that the way to cope with the rigors of medical training and being a doctor is to let off steam by getting drunk and or wasted in some other way?

Play And what is play? The word ‘play’ comes from words for exercise, movement, and leap for joy, or dance. We all know the joy of playing as a young child, which is what we did all day. Yet somewhere along the way we lose this joy, this sense that all of life is play, and come to associate the word with exercising in a way that is more hard work, or seeking relief from the tension of our lives in ways which can be destructive to our bodies – the things we have worked so hard (in a mental way) to learn to take care of.

When I was a young girl I used to love to play. I loved being in nature, dancing, and reading. Somewhere along the way these simple pleasures (and I) lost their shine, and my idea of play turned into drinking, partying and sex.

Partying has side effects

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PART 2 I partied a lot as a medical student and young doctor, and after all the short term effects – of saying and doing stupid things when I was not myself that I would never have done sober; putting my health and even my life at risk while drunk, making myself sick, wasting hard-earned money, destroying relationships – I ended up with long term effects, in a rehab with alcohol addiction. I nearly lost my job over it, and then lost my best friend to alcohol addiction, depression and ultimately suicide.

I now live a great life without any alcohol, but I am only able to do this because I have been willing to look at why I needed to drink in the first place.

I was raised to value myself for what I did, not just for who I was, so my sense of self-worth was fragile, and dependent on what others though of me. I was also raised to deal with stress by drinking from a very young age – by two doctor parents who also drank – so I literally had no other coping skills in life.

I had to look at why I felt so stressed, and to learn other ways of coping with that stress – ways that restored and revitalised me, rather than leaving me feeling like a train wreck.

For how can we truly care for others if we don’t truly care for ourselves?

Sure, the system needs to change too, but we are only going to change it from within, starting with ourselves. As we learn to be gentle and tender, to love and care for ourselves, and to value ourselves for who we are, not just for what we do, we will naturally bring that true care to everyone else we meet – our colleagues, our patients, our family and friends.

Why did I feel so stressed?

Medicine is a stressful profession

And we will then truly celebrate our selves and our lives with each other – no longer needing to party hard, because we are no longer hard on ourselves.

Medicine is a stressful profession, and it does not teach us to take care of ourselves at all – in fact, it asks us to care for everyone else, at our own expense, going without food, sleep, rest, play, and time to develop healthy relationships. The medical system does its best under difficult circumstances, but it is out of balance, and lacking true care and compassion for everyone in it, and we are its greatest casualties. The people in the system are amazing, and doing a great job, but we live with an enormous amount of tension, and sooner or later, we seek release and relief to cope.

Doctors have a much higher rate of substance abuse, addiction, depression and suicide than the general population, and we self-medicate a lot.

But what else can we do?

Is there another way to deal with stress and tension?

There are ways of dealing with stress that numb us from what we are feeling (like alcohol and other drugs) and there are ways that raise our awareness and help us to put things in perspective and see the bigger picture at play.

Taking moments to stop and check in with ourselves (whilst sitting on the toilet, is a good way to start) are a great way to stop the momentum if we are feeling out of control. Just stopping and taking a few gentle breaths can bring us back to a feeling of ease and calm, rather than denying the discomfort and unleashing it later, or burying it deeper with drink.

Talking is good, sharing how we are feeling with someone we trust, rather than bottling up our feeling of dis-ease, which can lead to disease!

Learning not to take things personally, or to make them personal, can spare us a lot of hurt and reaction and save a lot of time – seeing that everyone is doing their best under difficult circumstances, and that no one is trying to hurt us on purpose.

And remembering how we felt as a very young child, and what made us feel warm and yummy then, and choosing to do these simple things in our adult life, can keep us connected to the essence of who we are, the place inside us where no alcohol is needed.

Dr Anne Malatt Ophthalmologist, Bangalow, Australia MBBS, MS, FRANZCO, FRACS “I work as an eye surgeon in a country town in Australia, seeing patients in my private rooms, operating on people’s eyes in the local public and private hospital, and providing emergency services when called to.

I have a busy professional life and a rich personal life, filled with a husband, children, grandchildren and dear family and friends.

Life is generally grand, but it was not always so for me. I struggled with addiction to alcohol, cigarettes, coffee, chocolate, sugar and destructive relationships in my earlier years, lost a close friend to suicide, and found medical and surgical training disheartening and painful.

To have come from there, to a time and place where I am now free of addictions, healthy and happy, and now love life, work, and me, begs some questions like: “How?” and “Why?” I am naturally a private person, but I willingly share stories of my life to show that it is possible to come back from anything, that there is another way to live – a way that is naturally loving and joyful – and that anyone can live this way, no matter what we have done and where we have come from, if we so choose it.”

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It’s elemental

By Nicholas Stocks, Flinders Medical School student societies play an important role in the lives of their members. Obviously they are best known for social events such as O-week BBQs, End of Exam Parties and the obligatory Scrub (Pub) Crawls. Any event based around food, drink and loud music is always going to be popular with members, but there are other events that will potentially have a much longer and lasting impact on the lives of students. One such event that the Flinders Medical Student Society (FMSS) runs is the annual Mental Health in Medicine Seminar. At this event junior doctors and fellow students openly discuss their personal battles with mental health and how to cope in this tough industry. There are so many sources of stress for junior doctors, long hours, endless patients, complex procedures, and mountains of paperwork, that it is hard to believe anyone would be inclined to add more. Yet sadly this is not the case.

As James Lawler (President of AMSA) recently penned an article for the Sydney Morning Herald, “Teaching by humiliation has been an accepted part of training in medicine for years”.

Medicine has been one of the last professions to hold on to this culture, as was summed up perfectly by an online commenter in response to James’ article, “I have been a doctor for over 40 years, l learnt & taught by humiliation & intimidation. This was an effective form of learning, after all it is peoples lives we are discussing.” I find myself at great odds with the two main points of this statement.

Firstly the scientific evidence shows without any shadow of a doubt, teaching by humiliation and intimidation results in significantly poorer educational outcomes and has a negative impact on mental health. It creates tension, ruins rapport, sabotages accountability and crushes motivation. All of which are detrimental for the student and inevitably patient care.

Secondly I reject the long held belief that ‘lives at risk’ is an acceptable excuse for this type of behaviour. As a profession, we need to collectively step down from our high horse. We are not the only ones where our education and execution of our job impacts lives. I guarantee that the average airline pilot, bus driver or elevator mechanic holds more ‘lives in their hands’ on a daily basis than the average doctor. These industries have found a way to successfully educate their staff without the need for such negative tactics. In fact in most other work places this behaviour would simply not be tolerated and at minimum would result in a referral to the HR department.

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Senior doctors need to be aware that their words, actions and behaviours carry more weight with junior staff and that there is an inherent power imbalance. As such they must be more cognizant of the potential impact of their actions. It is time to break the cycle of educational bullying in medicine.

Staying healthy: FAQs

By Holly Richter, Flinders How do you do it?

You mustn’t sleep!

How do you find the time?

If I’d written this a year ago, it would have been from the perspective of someone spouting those questions. I was a happy and wide-eyed first year barely scraping the surface of a busy workload and juggling extracurricular commitments.

I looked at other medical students, particularly those in years above me, and wondered in disbelief how they could manage it all. Exercise, part time work, student societies, Tinder dates.

Binge watching Brooklyn 99. Passing med school.

But there are now people asking me these very same questions.

Often. With a look of incredulation, and a wary sort of scepticism, people will marvel at my busy schedule and comment ruefully that ‘I could just never do that’.

May I say from the outset that I do not think I work particularly harder than anyone else. I do not think I am cleverer, more talented or somehow ‘better’ because I do extracurricular activities. This is a common fear that niggles inside me, that when people see my busy schedule and hear my bumbling replies to their exclamations of shock all they are really hearing is ‘I am busier than you thus I feel I am better than you’. I think humility is one of the cornerstones of good leadership, and won’t for a second let my abilities be inflated beyond reality. Perhaps this is modesty, and I’m actually a super freak genius multitalented supermodel athlete, or perhaps this is born of insecurity and I am plagued with self-doubt. If I can be candid, I suspect it’s somewhere in the middle of that confused spectrum.

To briefly address those opening questions; I am organised, I know when to take a step back and give myself a break, I know who my true friends are, and I finally understand just how much I need my family nearby. I know that I like doing things. I enjoy learning, I love teaching, and I like the rewarding feeling that comes from the privilege of leadership. Playing sport is fun and an essential part of my life, and my housemate and I live in a tiny cottage that requires little maintenance hence I don’t have to stress often about housework. Being busy is not easy. But what is harder is not doing the things I love. I learnt this last year, when injury kept me on the sidelines for an entire season, and my mental health took a beating as a result.

So the lesson then is find, and do, what you like. Or even better, what you love. And if that happens to be spending hours every day going down the UptoDate rabbithole chasing knowledge, then great. Or, if that means sitting on a committee once a fortnight and also going out line dancing or coffee tasting or something equally as niche, then, well, rad. But know that you need to be physically and mentally well. Thus you must exercise.

You should try to eat healthily, but you also should be kind to yourself and not stress should you happen to consume an entire whopper meal and half a pizza after dancing particularly vigorously one night with your friends.

It would be naïve and arrogant to think that I am telling you something new. Other people will offer far better advice about how to manage your time well. I just wanted to share my story, because I quite like the way it is unfolding. Med school is full of opportunities, and you have the freedom to choose your own path and make it your own. As long as you manage to strike the right balance I suspect you’ll quite like the way your own story unfolds.

Panacea 11

75 Years of Trephine

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By Jocelyne Desoe and Rob Thomas, UQ Oh how times have changed. A bit.

1940

Four years after its birth in 1936, the Queensland Medical Students Association (later changed to UQMS in 1943) created it’s annual publication, Trephine. The Patron E. D. Ahern introduced it as a ‘means of expressing their ideals and objects, their grievances, real or imagined and their humour, simple or pungent’, and from the get-go Trephine has been that outspoken and entertaining voice of med students at the University of Queensland. In the very first issue, a poignant address from the President gives some insight into the situation faced by medical students during World War II. ‘Wider horizons beckon, other youths depart and we are left alone; often, indeed, branded with the stigma of cowardice. We will, however, grimly perform our allotted job in our lecture rooms, labs and wards… If stay at home we must, then let us do it efficiently.’

1960

This year’s claim to fame is the origin of Convention (and also AMSA). The first executive team of the Association of Australasian Medical Students consisted entirely of Queenslanders (yay!), and the first Convention was held in Brisbane, with 160 students from 5 different medical schools across Australia. Compared to the 56th Convention this year, with 1,200 students from 22 different medical schools, the 1960 event was a little different. Some interstate delegates were billeted with parents of Queensland students, and the first social night was a party at the secretary’s family home. They also had several trips to demonstrate the ward conditions of Brisbane hospitals.

Naturally, the convention report spans across 16 pages in the magazine and only hints at the true nature of their social adventures. ‘The chief purpose of Convention was, of course, the formation of the National Association’ and ‘furthermore, it is an old maxim that most important decisions are reached over one or numerous glasses of ale’. And so the tradition of Convention began.

1976

Past Trephines have been a goldmine for politically incorrect features, including a ‘Sexual Maladjustment Test’ and ‘Idi Amin on Opportunities for Graduates in Uganda’, which mockingly sells the political corruption in pidgin English, as well as a vast array of subjectively offensive cartoons. Thankfully there are also a decent number of less controversial pieces. It became tradition to include profiles of the current preclinical cohort at the back of each Trephine, and eventually the second years became the driving force behind the whole publication. This was also the historical year in which the first recorded bedpan race took place at the Med Ball at Cloudland. The verdict from the Med Ball organisers was “a smashing (!) success – but never again”. On a different note, a particular demonstration of poetic talent is ‘The Man from the Royal Exchange’, which begins:

“There was movement in the colon, for the bug had passed around And this ‘science course’ was giving us the runs…”

1994

The year of birth of our second year Queensland “twosies”, 1994 highlights just how far we’ve come in the computer age. “Gone are days of physically cutting and pasting and photocopying. In comes a very smooth operation of cutting information onto the computer and carrying out all the work in the ‘virtual computer world’”. Orientation Day in 1994 involved the last of the O-Day Boat Cruises for first years, which had only one minor drama. “Upon arrival we realised there was a slight problem. The boat had a capacity of 200 and we had quite a few more than 200…” Luckily the 20cent beers made everything better.

2015

Flicking back through 75 years of Trephine, it is clear that the value of the magazine lies in its entertainment and expression of opinion. This, of course, must be balanced with respecting the students in the published content, and thus ensued a LOT of debate over appropriate levels of censorship and confidentiality. Earlier this year, the highly topical ‘Sexual harassment rife in medical profession’ article incited an important discussion on sexual harassment and bullying in the medical profession, and made us particularly sensitive about discussing our fellow students’ personal lives. As a result, we revolutionised our annual Snog Chart so that students had to opt-in before being contacted about it at all. If they opted in, we then contacted them regarding the submissions we’d had, and offered to remove them, publish their name or sometimes use a nickname. Our theme for this issue is ‘Come Together’.

With feature interviews that exemplify the health professions uniting forces to solve individual and global problems, as well as a concerted effort to cover all aspects our diverse UQMS culture, we hope that the 2015 Trephine makes everyone feel part of something special.

In every long-standing tradition, parts of it grow and flourish while others eventually fall by the wayside or become less appropriate: it’s important to look back even as we step forward in our traditions and our careers. Likewise, each editorial team has found a balance between their serious reports and articles in Trephine, and showing off the varied and often hilarious activities we get up to. Bound copies of Trephine can be found at the State Library of Queensland, and at the UQMS office in Brisbane. This year’s 168-page copy will be made available at the second years’ final exams, both in print and online.

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Videoconferencing: the future of medical education?

By Stephen Pannell, UNDF

I’ve been very lucky this year to have been selected for the highly competitive Rural Clinical School of Western Australia (RCSWA). Most Australian medical schools have an equivalent programme. The RCSWA programme is spread across Western Australia, from Derby and Broome in the north, to Kalgoorlie in the east and Esperance and Albany in the state’s south.

Students in the programme spend their penultimate year of medical school living in a rural town attached to a rural hospital.

Whilst there are a number of programmes and incentives being implemented to address the shortage of doctors in rural areas, the Rural Clinical Schools around Australia are contributing a great deal to educating future rural doctors. The RCSWA programme has been successful with high rates of participants from urban backgrounds now working in rural areas.

Our curriculum covers obstetrics and gynaecology, paediatrics, surgery, ophthalmology, oncology, internal medicine, Aboriginal health and general practice. We learn through clinical placements with local general practitioners, hospital medical officers and visiting consultants and we have weekly small group tutorials and videoconferences.

Over the last few years the RCSWA has been increasing the utilisation of videoconferencing for both content delivery and content assessment.

We have frequent videoconference tutorials with the other 85 medical students spread over 14 sites around rural WA. A consultant, either from a secondary hospital at one of the larger sites, or from a metropolitan tertiary hospital, will deliver lectures via videoconference. An online web-form, known as an eClicker, with a number of MCQ’s and SAQ’s is distributed prior to the lecture to gauge our current understanding of the topic.

There’s also a number of videoconference ‘case based discussions’ throughout the year that are a part of our assessment for paediatrics and oncology. We dial in and present a case to a consultant who then assesses our presentation and asks us content specific questions. At our rural sites, there is always access to the videoconferencing system for students to dial

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into extra-curricular lectures and presentations that are based in Perth. Our local hospitals use the same videoconferencing system and this is utilised by local consultants each week to discuss complex cases with multi-disciplinary teams (MDT) based in Perth. For a medical student to be able to attend these MDT meetings whilst being in a rural area is a valuable learning experience.

Videoconferencing technology, telehealth, is becoming an increasingly important part of the delivery of health to Australians. Doctors working in both metro and rural settings will need to be able to use the technology, they should understand videoconferencing etiquette and they’ll be required to be proficient with consultations and patient interaction via videoconferencing links. It is for these reasons that the further integration of videoconferencing technology into the medical curriculum is so important.

Reliable and fast data connectivity is also an important factor that many rural areas in Australia are yet to attain.

Videoconferencing quality, both audio streams and video streams require fast data download and upload bandwidth.

Even with our current advanced data compression protocols, satellite connections are too slow. With high-resolution video, clear audio, and fast access to pathology and radiology images, optic fibre connections with fast and reliable peak and off-peak upload and download speeds are necessary.

As medical students and health advocates, it is important that we see first hand how this technology is improving patient outcomes. By facilitating communication between rural and urban colleagues we are contributing to a more equitable health care system for all Australians regardless of geographic location.

Republished from Panacea Volume 48, Edition 2.

November 2014

Doctor on call: telemedicine and the future of healthcare

By Nathan Abraham and Luke Fletcher, Monash

One of the first things that we ever learn in medical school is the basics of interacting with patients. Everything from the introduction with a handshake and a smile, to sitting at eye level with patients - ensuring to remove barriers between you and the patient, and making sure to sit at an angle rather than face on with the patient. All these steps are taken to ensure that the medical conversation can be relaxed, and try to replicate normal interaction and communication. With this background, the increasing push for telemedicine and online health solutions in the clinical setting may seem odd.

Telemedicine and telehealth refer to the use of technology and telecommunications infrastructure to deliver healthcare at an extended distance. This can range from something as small as in-home vital signs monitoring via telecommunications networks to performing surgeries via a DaVinci robot. While this sounds very futuristic, a recent article in The Economist reports the use of television links to facilitate patient consultations in 1924. With many advances being made in the interim, such as biotelemetry (used for space missions in the 60s), telehealth has the potential to transform the way we interact with patients and deliver healthcare.

In Australia, telemedicine usually refers to of the use of videoconsulting for specialists in remote areas. There are many benefits to the use of this technology, primarily by reducing the need for face-to-face consulting. This will save a great deal of resources and time for governments, patients, and doctors alike. Indeed, with the issues faced in attracting doctors to practice rurally; telehealth solutions could provide a way of serving remote communities, while allowing doctors to maintain the comfort and convenience of a metropolitan life. In a country as sparsely populated as Australia, this would mean a specialist in Sydney would be able to serve patients in Broken Hill and Orange, without the need to leave their life and family in the eastern suburbs.

However, there have been questions around whether telemedicine can truly replace the need for in-person consultations. Indeed, despite being available for many years, there are many complex issues that stop it being from rolled-out and becoming mainstream. Simple issues such as lack of ability to conduct an adequate physical examination, something we are taught is a cornerstone of clinical medicine, may stop this technology from realising the dreams many people hold for it.

Other issues include the lack of a reliable backhaul infrastructure. Most notably, networking and telecommunications in Australia is a big inhibitor, and indeed, one of the selling points of the former Labor Government’s FTTH NBN proposal was its potential telehealth benefits to clinical medicine. In addition, the significant initial capital investment in installing remote technology devices means there is a short-term pain that governments must swallow in order for the potential savings to be realised in the future.

Concerns have also been raised around the additional issues of relying on e-health solutions in general. People are often anxious about how internet and data security can pose a significant threat to their private and confidential information, especially when relying on public telecommunications system to transmit sensitive information. However, as we move into the video-consulting arena, it may be difficult to ensure consultations cannot be recorded or intercepted. This has significant consequences if a video-consultation requires the patient to remove clothing for examination.

As it stands, Medicare subsidised telehealth consultations are available those who are living in RA 2-5 classified regions; as well as those who are in eligible residential aged care facilities, and ATSI health services. Also, there are Commonwealth subsidies available to practitioners, to assist with the initial setup costs of telehealth facilities.

However, while telemedicine can be revolutionary in the delivery of healthcare to remote locations, the role of doctors working in rural areas has not been made redundant (yet).

The Federal Government continues to encourage doctors to practice rurally in-person, and support the training of Rural Generalists. Ultimately, a Rural Generalist’s ingenuity, flexibility, and unique skillsets will still be needed to support, and compliment telehealth delivery. Regardless of the distribution and robustness of telemedicine; there will always be a need for a doctor’s presence to examine patients, and a doctor’s presence in case the power fails.

Republished from Panacea Volume 48, Edition 2.

November 2014

Panacea 15

Thriving versus only just surviving medical school

By Stephanie Pommerel, UQ

I started medicine at the beginning of 2015 as prepared as I could be. GAMSAT preparation was itself a three-month intensive, punctuated by work and guided by a self-directed schedule not unlike that of an athlete, albeit academic instead of physical. Moments where I wasn’t looking at textbooks were spent avidly reading articles in the Australian, about matters I felt traditionally uninterested in, and later practicing essay writing. Sitting the 7-hour entrance exam was one of the most incredible experiences of my life.

As the year progressed beyond the exam, I returned to my science studies part-time while working two jobs totalling fulltime hours through the week. People – my family, friends and colleagues – thought I was amazing to be able to keep pace with my workload. They shook their head when I replied to their questions about what I was up to, saying they didn’t know how I did it!

Then I started medical school. I had never before experienced nor, importantly, expected the level of busy-ness I was to come to understand was normal and if not unquestioned, accepted as the requirements of medical school. It became crucially important for me to continue to develop the support strategies that had allowed me to be as busy and productive as I had been in the previous years.

Living at home with my parents, being able to debrief with them, able to discuss the enormity of the workload, my failure to keep up at times, verbally working through the planned schedule of

16 Panacea

approach, airing my own feelings of inadequacy, and hearing their words of advice has been invaluable. After all, these two people have known me since before I was born. They have seen my growth and development; they know my own inherent qualities that place me perfectly for eventual medical practice.

Combined with close friends and extended family, such support keeps me grounded, providing a well needed reality check at times.

Although I unquestionably love living with my parents, I do not use their presence as a crutch. I am an adult who has lived out of home for many years, continue working one day a week and remain financially independent. I approached coming to live at home as a share-house situation. This means I buy my own food, then prepare and cook it for myself. I do my own washing and ironing. I clean the part of the house I live in, with the benefit of being able to share and support each other in chores and meals when we agree we are able to.

To this end, I take time out on my weekends to cook up ‘vats’ of food that I then freeze in containers. I might cook for myself a roast with plenty of vegetables so I can have ready-made lunches and dinners through the week. I eat a lot of fish, knowing the basics of the fatty acids contained therein as supportive for brain function. Through much trial and error over the preceding 10 years, I have eliminated substances that dull my body – foods that make me feel heavy, sleepy, tired, cranky or not ‘switched on’ after eating. This has seen me eliminate alcohol, caffeine, sugar, denser carbohydrates like potatoes and rice, amongst others.

Exercise also has its place, with a commitment to go to the gym between one to three times per week, depending on my schedule. If I can’t make that, then I will make a point of walking 20 minutes to half an hour, just appreciating the beauty of the world around me. I love to walk along the river after a day at uni, observing the trees with their flowers and foliage, the birds, the character of the clouds and the colours of the day in its sunset. I make a point to walk with conscious presence: feeling my feet as they strike the ground, feeling and noting where in my body tension has gathered, my arms swinging and my hips swaying naturally as I walk. I often meet others along the way and greet them with a smile; somehow, all of this puts enjoyment back in my day.

Despite the pressures of medical school, I am here because I love medicine, and I see the potential for not only my own personal growth through its expression, but also for that of my colleagues around me, as well as the field of medicine as a whole. By regularly reconnecting to the reasons I have chosen medicine, appreciating the qualities in myself that place me so well to practice it, I can reflect on each day’s course, seeing moments that I have truly enjoyed. I monitor my energy levels and note how well I am not only able to achieve, but also to relax, to release and let go the pressures that build during the medical course. These methods ensure that the first glimpse of feeling overwhelmed, burdened, or ‘over it’ are readily detected and techniques can be employed to regroup and recover my sense of enjoyment.

I know not all students are as fortunate as I to be attending university in their hometown, some not even in their primary language, so naturally their social networks will be different to mine. However, I encourage each of my colleagues to rediscover for themselves tools that truly support them and to have the honesty to discard those that hinder. I used to feel that discipline was a dirty word, but I know now there is no way I would be able to do what I do without enormous commitment and discipline to complete each required step as I progress.

This approach tempers overachievement, which is short-lived and exhausting in its run, taking an enormous amount of energy to sustain. Conversely, I know that my approach will continue to develop as I enter rotations in hospitals and beyond, into general practice. I look forward to these challenges beyond medical school and to further evolving not just my own selfcaring techniques, but supporting other students to find theirs.

This article was first published at www.myhealthcareer.com. au and is republished with permission by the author

I have come to learn that if I don’t reconnect in this way to myself and to nature, I go to sleep and wake at night stuck on a mental program – running through disease mechanisms, or worse, what I haven’t been able to get done that day or week, and the more that always awaits me. To wake exhausted, as many medical students do, creates a chore of the next day, a leaching of enjoyment, an inability to completely take in information, as well as mood changes and general feelings of struggling to cope. So begins the precipitous slope to burnout.

Panacea 17

...runaway JULY 2  9

You’re on the beach, with the sun warmly softening your skin.

Laugher can be heard in the distance, but it is so quiet over the crash of the waves. It is serene. Your head feels light. Open your eyes. You see blue skies and palm trees. A man in a taco costume runs past you.

Wait, what?

AMSA Convention started 57 years ago, when a group of Queensland medical students gathered around a pint to share their experiences of medical school. In 2016, it’s returning to its home state for the first ever Convention in Townsville. Expect seven days and nights of remarkable academics, next level networking and a social program that will ascend to new heights. This will be a truly unique Convention in a truly unique location.

We cannot wait to warmly welcome each and every one of you to Townsville.

Runaway to paradise with us.

Stay in the loop by liking AMSA National Convention Townsville 2016 on Facebook, or @townsville2016 on Instagram and Snapchat.

20 Panacea

PLAY Panacea 21

The Day Off, or Frogging

By Toby Brunckhorst, UQ “Do you have the day off?”

“Yeah I think I do” “Let’s go” The start of another glorious day of play. An afternoon at Frog Buttress.

Frog (or Mt French to those who pursue more horizontal pursuits) looks like a scar on the side of a non-descript hill amongst the more significant peaks of the scenic rim, south of Brisbane.

On closer examination, the scar reveals itself as a magnificent sweep of vertical, orange rock split into columns by crack after crack. Turning around you can take in the view over the fertile flats sitting below the steep, imposing basin left by an ancient volcano. It is, in short, a rock climber’s paradise.

I first went climbing in high school and I was hooked. It is an art, a physical puzzle, a mind game, a challenge. Lead climbing (tied on to a rope that trails below you) requires complete focus – a slip at the wrong time could be ankle breaking or worse.

Dave and I met in first year, somehow discovering that we both climbed. Quick trips to our local crag in the city soon followed.

Growing more adventurous we sailed high above the trees, high above the thoughts of the ground as we traversed the long, lazy sport routes of Mt Tibrogargan.

The sun sinks toward the mountains on the horizon. The rock glows as I belay Dave up the climb, drinking the warmth and colour.

Then we discovered Frog. It is impossible to be stressed if you are at Frog. Negative emotions can’t even reach the crag, dissipating during the pre-climb pie stop. It is impossible to talk about differential diagnoses, OSCES or prognoses.

An aeromedical helicopter flies past, below us. Perhaps a patient is waiting to be taken to Brisbane. But that is a world away. It is not in our world. Not yet, not now.

The long cracks are completely absorbing, leaving no room for any other thought. A foot here, shift the weight, place protection, clip the rope, adjust a hand. A slip! A racing heart (tachycardia is a word for the ground, not a word of Frog).

Breath deeply. Look down. Breath again. One more piece of protection goes in. Focus. Step up.

Darkness settles as we abseil down and scramble along the cliff base and back to the car. We sit quietly as we begin the drive, our minds still on the rock, in the sun, the world at our feet.

Refreshed, we arrive back in Brisbane. Ready to read, and learn, and listen, and examine. Frog is an escape that makes study so much easier.

22 Panacea

Exercising mind and body?

By Luncinda Clay, UNDS It’s 5pm on a cold winter’s Monday. Sitting in a PBL room at university, day slipping into night, a daunting to-do list stares at you after a not-so-productive weekend. Learning objectives seem to cover diseases you have never heard of, let alone studied. Meanwhile running gear peaks optimistically out of your backpack. The Med Society running club starts in just a few minutes.

Maybe give it a miss this week. But that’s what you said last week, when you promised your healthy self that you would definitely go this week. Then you hear – “you coming running?”

Yes, got to do it. And no regrets after a solid hour of foggy sweating with several fellow students jogging under Sydney street lights.

The to-do list is still the same. But maybe it doesn’t look quite as daunting after all.

As we all know too well, medical school is hard. The work, although intensely interesting, can be unrelenting. And it is all too easy to forego exercise or sport to finish that case presentation or chapter of Talley and O’Conner. However, that isn’t always, or usually, the best decision we can make.

Copious research tells of the benefits of physical activity. Not just for our physical health, which is self-evident, but also our mental health, and exercise can even improve academic performance. Exercise is part of achieving work-life balance.

But it’s not enough to say “Just do it”- every medical society should be encouraging and facilitating sport and exercise as a regular feature of the medical program.

courts, in friendly and occasionally intense, competition. The annual soccer, rugby and touch comp against Sydney Med School is another highlight. But what does this achieve, and it is enough? I mean no-one is going to get or stay fit on 3 games of touch footy a year.

We should recognise that one of the great attractions of sport is how it can bring people together. Those from different cohorts, different faculties, different universities, different social groups – all with a common love for the game, whatever game that may be. Sport provides a wonderful opportunity to meet new people, whether they become life-long friends or life-long rivals, regardless of skill levels too.

In that way, involvement is a positive and enriching experience.

A delightful diversion from the pressures of study and the rest of life. But the challenge for us all is to make exercise part of our weekly routine.

So schedule it in. Find an exercise buddy. If you are already in that routine, then please support and encourage the rest of us to join you, in whatever it might be.

So next Monday evening, dust off those running shoes and get away from that work. Go along to running club, or yoga or football or whatever it is that you most enjoy. It might make more of a difference than you think!

MANDUS cohort at the 2015 NSW Medical Students Council Sports Day i

It can be something as simple as a running club – informal, noncompulsory, but still a regular event where there will always be a running buddy, and supportive company. And someone to push you that little bit harder.

Then there are other more structured opportunities, on a bigger scale. The Medical Association for Notre Dame University Sydney (MANDUS) (which I represent) competes in an annual inter-faculty sports night, which brings a diverse range of students, with an equally diverse range of skills, to the oval and

Panacea 23

I can’t help

but run

from my

problems

24 Panacea

By Joseph Mohan, UWA My Name is Jo and I have to confess that I have a problem. I am addicted to exercise and have been for many years now.

I have tried everything to kick the habit but nothing works. I once went a whole two months without exercising, but life’s stressors bore down on me once more and I could not help but succumb. I simply cannot live without the sweet sensation of sweat on my brow and the satisfying ache in my muscles.

Sure, on the surface I look normal to the world, but little does everyone know of my midnight runs through the streets of Perth or the strangers I covertly meet up with to do Yoga. On the inside, I am disgusted, and ashamed of who I have become.

With total disregard for patient safety and infection control, I consciously wear my shirtsleeves to the wrist, hiding my forearms from view. Masking my grotesque vascularity, the telltale sign of the monster I have become.

I have cut the lines and severed all my ties, until there is nothing left but exercise and the insatiable desire for the runner’s high.

Marathons, sled pulls, burpees, planks, I have killed myself time and time again chasing it. I know that Dr. Jekyll has well and truly died but I do not want to Hyde who I am any longer. I know there’s no hope for me. There’s no choice, it’s either run or die.

But by exposing myself, and my story to all of you, at least you can learn from my mistakes before it’s too late.

My story began like any other. As a normal teenager, I just wanted to socialise with those around me and be accepted.

Naturally, peer pressure played a big part in my youth so I dabbled in things illicit- a social run here, a gym session there, it didn’t mean much to me at the time. Unsurprisingly, it choked my lungs and made my head spin, and I’d always wake up the next morning in a terrible state (DOMS). Yes, I hated the way it made me feel inside but I knew I was in control and that I could stop at any point if I wanted to. Or at least I thought.

This exercise thing was clearly ravaging my body, but little did I know of the terrible effect it was having on my brain. Slowly, it began to eat away at my mind and change the way I felt and thought about things. My mind felt sharper, clearer more focused, my body stronger. My friends and family noticed and were beginning to get worried. They said I wasn’t acting like myself. They didn’t like the strange new people I was hanging out with at odd hours of the day. No longer was I up late drinking and partying like a normal eighteen year old, but in bed by 9pm to promote maximal recovery. While I was never caught, I swear my mum always knew what I was up to. There I was, on tiptoe at 5:00am - quietly sneaking into the kitchen, and raiding her pantry and fridge to make myself a healthy breakfast of eggs and muesli.

One does not simply go rowing on the Brisbane river on an empty stomach. Before I knew it, goals, order and aspirations all started to take shape and align with this new sense of discipline that had burrowed deep in my mind. My life was rapidly spiraling out of control, and whole chapters were flying by at a dizzying pace.

Biomedical science graduate. Acceptance to Medicine. Move to Western Australia. Progression to the clinical phase. Where did it all go wrong? There were so many things I wanted to be, and now I am set on this dead end path with no prospects, all thanks to exercise. I will probably die a doctor.

I cannot change who I am now, but please I beg of you, whatever you do, whatever your friends coax you to do; for the love of god do not exercise. Papers have been published about its merits in health, emotional stability and even reduction in osteoporotic risk, but no one ever talks of the risk of addiction, or the power it has to consume your life. I’m not proud of it, but this desire to exercise and push my body to its limits has taken me to some very cold and dark places (top of Mt. Kilimanjaro at night); and now there is simply no going back.

TLDR; Note to self: You’re a med student so don’t waste all your time exercising and writing about exercise when you should be learning about Parkinson’s disease during your Geriatric rotation.

Panacea 25

Sports and

social around

the country: a collection of reports University of New England

By Edward Brentnall, UNE As part of the 2015 year, the UNEMSA committee aimed to create and facilitate various sporting and other exercise events to ensure students were staying physically active and getting much needed breaks from study – a work/play balance!

We strongly believed as a committee that by providing environments where sports and exercise were accessible in a fun, relaxing and sociable environment, we could improve student’s physical and mental health and ultimately help them to study better.

A large part of this effort was seen in the form of sporting team subsidies in local and university competitions. Financial subsidies saw by far our biggest year of sports, with 5 mixed netball teams, a cricket team, a basketball team and 3 football teams being filled. The social context of these sports teams has encouraged and allowed for students to get away from the books and remain active.

We realise that exam time is a stressful time for all students, and wanted to provide opportunities for students to clear their heads and take a break. This year we trialled funding multiple Body Balance classes (at the university gym) around exam times. Body Balance is an exercise class that crosses Pilates, yoga in an aim to relax participants. With good turn outs and feedback to these events we look forward to continuing to run them in the future.

26 Panacea

With a focus not only on physical health but also mental health we aimed to host events that allowed students to socialize with each other in a fun and relaxing manner. We ran a skating and bowling night for our students this year which provided a really informal and relaxed place for students socialize with one another whilst raising funds for Beyond Blue.

Achieving and promoting a healthy work-life balance has been something that we have attempted to make more available for our students in 2015. We look forward to continuing current initiatives and starting new ones in the future to better our students experience whilst at uni.

Monash: The

Caduceus Cup

By Sanjay Naidu, Monash

It was a chilly Saturday morning; the dew was glistening on the grass and the pounding of war drums could be heard across the sleepy suburb of Kew. The nervous energy and the building anticipation could be felt rippling across Trinity Grammar as starry eyed medical students arrived. Their heads filled with hopes and dreams of grandeur and lifting that beautiful golden trophy. There had been whispered rumours that this year’s trophy had been crafted from the finest plastic by a blind monk trained in the ancient and mystic art of plastic carving. In a timeless tradition, the various year levels of medicine were ready to undergo battle putting their bodies and pride on the line.

There were a series of trials of physical endurance that they would have to face to weed out the weak from the strong, the weak willed and the dedicated, the mentally weak and the sharp witted and well just the weak in general. The demons each year level had to face were named, Netball, Dodgeball, Soccer, Tug of War and of course the dreaded boat races.

With spirits high and the sun shining, the day begun, the police had been put on notice in case riots broke out amongst the crowds cheering in the Netball stadium.

The natural talent on display was phenomenal and it could only be rivalled by the fierce intensity of those playing. The passion shown, reminded spectators of the gritty and savage underground street netball Melbourne was famous for and it was this same place many of the final year team got their start.

At the soccer pitches, there was history being made. It is a rare occasion when an empire is formed right in front of our very eyes but this is exactly what happened as the uprising of the

blue third year empire began exerting their utmost dominance over the other teams.

Without conceding a goal and finishing the tournament undefeated the third year team will have trouble to follow this performance next year mostly because a great number of their team were scouted by leading European clubs. After hours of gruelling effort, blood, sweat, tears and many fluid replacement drips the victors were crowned – the final year cohort finishing their degree holding the trophy they had dreamt of since they sat the UMAT.

Continue g Panacea 27

f

Continued

While the day may not have had the same amount of drama or exactly unfolded like that, a great time was had by all. For years to come as the future of the Australian healthcare system we will be slogging it out side by side, so it was a nice change of pace to unify in competition, and enjoy some good spirited sportsmanship. So once again the Caduceus Cup brought us together as colleagues, friends, family in arms through becoming rivals.

UNSW: The College Cup

By Andrew Fong and Kerry Xue, UNSW UNSW Medical Society runs an inaugural College Cup each year that brings forth multiple social sport events between students, representing each of their four colleges. This competition has an easy-going atmosphere, whilst still being competitive, encourages students to participate in team sports for exercise as well as a means to have fun, and socialise with students across the program.

This year we introduced an afternoon of Ultimate Frisbee into the College Cup. Many students found this sport to be more accessible for participation, and in turn there was great attendance and we’d hopefully be looking to continue its inclusion. Our other sports of touch football, soccer, netball and basketball have been a chance for students to exemplify their co-curricular skills and furthermore can be a great spectator sport for onlookers. Although some levels of skill can act as a deterrent for some players, each team rotates though with running substitutions allowing ample opportunity for everyone to participate and play.

Many of our colleagues have found College Cup as a chance for some friendly competition, and to develop some camaraderie within their colleges. It has been a great way to stay active with casual team sports, where a busy study schedule can sometimes be restricting.

And more from UNSW

By Nadine Kauleyand Terence Luo, UNSW As far as social events go when you are a medical student, the multiple parties held throughout the year are definitely memorable moments – for both good and bad reasons…

Holding these are always amazing, fun and extremely rewarding, though equally so are our other events where we can enjoy 28 Panacea

some time away (hopefully far, far away) from our studies – and at UNSW, these are our annual Classical and Talent Quests.

These nights are fantastic opportunities to show that medical students are anything but one-dimensional, having an appreciation for more than just odd rashes and anatomy classes. The amount of sheer talent that we have seen at these events alone is testament to how incredible some of our peers are at managing their time, ensuring they save some to pursue and practise what they love.

Stand-up comedy, dance, magic, music from all time periods and cultures – we have seen it all, and cannot wait to see what’s in store at this year’s Talent Quest in just over a month’s time. Both nights also see us maintain a connection to faculty and alumni, who often come to judge our performers.

Ultimately, we love seeing and appreciating just what amazing things our colleagues can do, especially as we often forget that we are more than just the degree we are studying, with so much to offer to the profession which we will soon be entering!

Griffith’s Medvengers

By Douglas Roche, Griffith

The (immaculate) conception of Med Revue 2015 took place almost a year ago amongst ecstatic post-med-revue highs.

Countless rewrites, rehearsals, and facebook notifications later, the show is finally over.

This year, Med Revue considered what it would be like if The Avengers were forced to attend Griffith Med School. Highlights included a rap battle between twosies and staff, a skit depicting how a MET call would be conducted by allied health, and an a capella mashup of specialty stereotypes.

While having been performed at other universities for generations, this year marks only the fourth incarnation of Med Revue at Griffith. As convenors, we’ve been inspired by the work (and puns) of our predecessors, and those who have now been in all four productions. This year was the biggest Med Revue ever, and we have relished the challenge of collaborating with our talented cast.

Continue g Panacea 29

f

Continued

A unique initiative this year was a charity matinee show to support one of our fellow medical students in Project AP, which will facilitate him buying an exoskeleton so he can fully participate in medical education.

We can’t express enough how grateful we are to everyone who has made Med Revue possible. The number of hours put into this show is truly immense – there’s no doubt that Med Revue took up a substantial part of the lives of those involved. But it’s such a unique and valuable experience that we can’t imagine what our med school lives would be without it.

Sydney University

By Jack Luxford and Emma Cumming, USyd

Over the past few years, the Sydney University Medical Society (SUMS) has incorporated an increasing array of activities and programs aimed at promoting and facilitating the mental health and wellbeing of our medical students. This year, the portfolio introduced a number of new initiatives, under the able guidance of our Health & Wellbeing officer, 2nd year student Emma Cumming.

As always, we offer our first years the opportunity to be paired up with a senior student in a buddy program, to get them over the big change that is the step into medical study. Particularly for those with a non-science background, this is a great opportunity to share tips on how to avoid pitfalls, manage the workload, and where to go for a great time when you’re not studying! And to congratulate them on completing their first exam, we surprised them with cookies and cakes and hugs!!

This year we’ve started up the SUMS walking club - to take advantage of the great natural environment Sydney has to offer (soz Melbourne, we still win on that) - and encourage medical students to get outdoors and balance work with life!

We’ve taken students on cliff top walks and beachside trails even discovering new places for those who’ve been Sydney residents all of their lives!

Another first this year was our inaugural Mental Health Forum, which brought together medical students to share their difficult but empowering stories of resilience in the face of mental illness.

With medical students shouldering a huge burden of mental ill health, it was an opportunity to have a frank discussion about the difficulties of studying medicine and balancing a life with it, and was an opportunity for students to learn from the experiences of others. Four of our students shared their stories, and all present were touched by how open and brave they were in contributing to breaking down the stigma surrounding discussions of mental health in the medical community.

30 Panacea

Medical societies can play a huge role in balancing out the serious side of study - with parties, and social activities, sure - but also by engendering and creating opportunities for students to explore facets of their lives that might traditionally have been neglected. With our Health & Wellbeing program, we’re proud to contribute to that.

UQ: the Ashintosh Foundation

By Clare Feeny, UQ

It is difficult to tell who benefits more from the Ashintosh Foundation’s events; the communities targeted by the charity events, or the medical students themselves. Ashintosh is the charity arm of the UQMS, and is involved in a range of social and cultural events that are an integral part of medical student life.

Teddy Bear Hospital is one of Ashintosh’s main initiatives, and involves a small group of medical students visiting prep students to teach them about health, and foster positive relationships with the health profession. It is impossible to come away from a Teddy Bear Hospital visit feeling worse than when you came in. The children’s enthusiasm is infectious and each visit is both heart-warming and entertaining. Medical students describe the visits as not only a good study break, but a great way to feel like you are contributing to the medical community.

Ashintosh also hosts a range of cultural events that provide students with an outlet for their musical talents. The relaxed atmosphere of the Coffeehouse nights are a great place to enjoy acoustic music, great coffee and stunning photography all provided by the cohort’s talented medical peers. The Battle of the Bands is a more upbeat night, where medical students get to cheer on their musical peers as they compete against law students. The Jazz Gala shifts the mood again and exhibits the smooth and sultry musical talents of the cohort. Finally, lovers of classical music enjoy the Queensland Medical Orchestra concerts, which provide a refined and enriching escape from study.

of Ashintosh (including the Foundation’s mascot, Big Ted) participate in the Bridge to Brisbane 10km fun run. Another highlight of the sporting year is the Brisbane to Gold Coast 100km cycle, which sees some of Ashintosh’s more athletic members taking an invigorating and challenging break from study.

Over the years, the Ashintosh Foundation has strived to support not only a large number of charity events, but a range of events with sufficient diversity to engage medical students and the range of interests they encompass.

Many students enjoy the sporting opportunities Ashintosh provides, not just for the athletic and health benefits, but for the social aspect as well. The Ashintosh Foundation Running Club is an ongoing social running group. Many members Panacea 31

Hacking to health

By Ben O’Sullivan, Deakin I play golf. I am not very good.

If you subscribe to the stereotype, I am not the only person in the healthcare profession who indulges in the pastime. Doctors and golf have long been entwined. It is said that Hippocrates, the father of medicine, could hit a mean two iron stinger in his day and since the stereotype has only continued to be propagated.

Whilst most people in their twenties may find the game boring, slow, or even superfluous. I do not. I believe that the simple game is the perfect accompaniment to a medical career. I am here to explore the allure of the game and why you, the medical professional, should take up the game.

1. Accessibility Golf, created in Scotland in in the 15th century, was once the game of kings and queens. Whilst the game may maintain a perception of exclusivity, golf is now widely available to even plebs like me. A game at my local course cost $9.95 for 9 holes.

If you take 50 shots to get around the course, that is roughly 20 cents per shot. That is some cheap entertainment!

2. Exercise ‘Exercise?’ I hear you say. ‘Golf is a sport played by fat old men who don’t even get a sweat up!’ Whilst this may be the perception, the evidence is to the contrary. 18 holes of golf takes on average 11,948 steps, which is well above the recommended minimum daily requirement. (1) Furthermore, old people who play golf have improved general health and balance, whilst primary school kids had a reduced rate of obesity from a generous dose of golf. (2) Golf has been shown to be effective moderate aerobic training for middle-aged people. (3) Finally, the beauty of golf is that the worse you are at it, the greater the benefit.

For me, I might take up to 20,000 steps as I zig-zag around the course, hacking my way through trees, stomping the long grass trying to find the pesky lost ball. This is ramping up my caloric expenditure. Jason Day, the Australian who recently claimed the world number one ranking, does not get this benefit though. He is the victim of his own efficient and effective game.

3. Constant challenge The question that I keep coming back to though is why so many doctors play golf. One could argue that previously the game was exclusive and doctors were well placed in society to obtain access. However, I believe that it is something much more primal than that. Doctors love a challenge. It is the sole reason some people sign up to the profession. The art of medicine, much like 32 Panacea

golf, is something that can never be perfected. The perfect round cannot be obtained, nor the perfect ward round. Even Kim Jong Il’s famed round of 34 shots, beating the previous world record by a mere 21 shots, still only contained 11 hole-in-ones.

On seven holes, the dictator was still less than perfect.

For most who pick up the clubs, making consistent contact with the ball is a struggle. Mastering the sport is something that can take decades. It is the perfect perpetual tease of a challenge that sucks in people who love a challenge. That is why doctors are known to be allured to the sport, in my opinion.

4. Longevity Finally, you can play golf forever! I have seen many a heart attack victims in ED or ICU who have collapsed whilst on the golf course. It is not the golf that has killed them, it’s the fact they were able to continue to play the sport long after most other recreational activities had to be ceased. A large study of 300,000 golfers estimated an increased life expectancy of five years! (4) Golf had kept them alive, both physically and mentally.

So with October being Golf Month 2015 in Australia, there is no better time to get out there and smash around some little white balls. Whether it be for mental or physical health, social interaction or the perpetual challenge, I’d recommend joining me in the 2015/16 summer of golf.* *sunscreen not provided, but recommended.

1.

2.

3.

4.

Kobriger SL, Smith J, Hollman JH, Smith AM. The contribution of golf to daily physical activity recommendations: How many steps does it take to complete a round of golf?

Mayo Clinic Proceedings. 2006;81(8):1041-3.

Taylor RW, McAuley KA, Williams SM, Barbezat W, Nielsen G, Mann JI. Reducing weight gain in children through enhancing physical activity and nutrition: The APPLE project. International Journal of Pediatric Obesity.

2006;1(3):146-52.

Broman G, Johnsson L, Kaijser L. Golf: A high intensity interval activity for elderly men. Aging clinical and experimental research. 2004;16(5):375-81.

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Photo credits: Mitch Hodgson

Play: The Antidote

By Sarah Reeve, UWA Although there is significant diversity among medical students, there is a tendency toward character traits that make for a high level of responsibility and expectation within and outside of medicine. Medical students are generally intelligent, respected, competent and reliable. As such, we often find ourselves in positions of responsibility, whether we ask for them or not. We find people looking to us for care and advice, confiding in us, and expecting us to help with serious predicaments and decisions.

These may be patients, colleagues, friends, family members, or others.

However, our capacity to care for people has a limit. Everyone does. Though medical students may be genuinely caring individuals, who often have a greater capacity for this than most, it does not negate our humanness. We need an antidote to this emotional, mental and even physical drain on our personal resources. The reflexive response may be “just do less stuff”, or “learn to say no”. This may be true and sound advice for many, just doing less is, at best, only a partial solution.

This idea was first presented to me by Professor Bruce Robinson, who called the ‘caring’ role, the ‘parent’ role, consistent with transactional analysis psychological theory, pioneered by psychiatrist Eric Berne in the 1950s. Stigma of the idea of paternalism in medicine aside, there is undoubtedly truth to the imbalance of power in many care-provider relationships. In and out of medicine we find ourselves in this ‘parent’ role all too often.

This takes a significant toll on medical students, and doctors, and it would seem that we are not in the best profession for healthy outlets given our startling rates of alcohol and substance use, divorce, and pervasive, persistent mental illness.

So, what is the suggested antidote? It is to seek and nurture the times, places, and people with which we can live in the ‘child’ role.

This doesn’t necessarily mean being immature and irresponsible.

It means finding the places and people with whom you are cared for, safe, and accepted. To be part of something larger than yourself, free to truly enjoy, and to play, without fear.

This will look different for different people. It may be in particular relationships – with a partner, close friends, your family. It may be in a sport team, or even attending sporting or other events, where you are part of the crowd, marveling at the feats of others. Those of faith may find comfort and perspective in God. It may be at the beach, or in the bush; marveling at a world more vast and wonderful than you can fathom. We need these experiences and relationships where we are free, and safe, to play.

Play should not be something we just assume we are doing if we are doing anything enjoyable other than work. This kind of healthy, enriching, quality experience should be sought and treasured. The pure, unfettered childlike joy, playing freely where we are loved, accepted and safe is the antidote to our lives of potentially overwhelming responsibility.

Thanks to Professor Bruce Robinson for introducing me to this helpful concept.

Panacea 33

Remaining in the moment

By Samuel Grenfell-Dexter, UQ

In Brisbane, people normally catch a glimpse of rowers while taking the ferry across town. But, for me, rowing became a regular part of my mornings. I started around the same time I started medicine.

Surprisingly, it has not taken time away from medicine, but instead given me the opportunity to look at learning in a new light. After moving to Brisbane as an international student I was looking to try new things and joined a crew rowing from the university boat house. I was first drawn to rowing by the apparent simplicity. It’s seemed like a basic skill I could easily learn. I quickly realized how wrong my assumptions were. There is one essential movement that moves the boat, the stroke, which can somehow be calming, inspiring, or push you physically, but always challenging.

A popular sentiment in sports is the importance of coming to training with the right mentality, being prepared to work hard and focus on every drill, giving it your all. The idea being the game will take care of it self. It’s in training where I will improve my stroke and embrace the importance of discomfort, so that at the next regatta it comes naturally. The rhythm I found in rowing has carried over to learning and parallels strongly with the challenges of finding my way in medicine. Every challenge feels like an additional opportunity to recover and reassess the progress made. So the next time you’re caught off guard during clinicals and told: “Examine the patient, tell me what you think” – embrace the uneasiness and take a deep breath – its all part of learning.

A large part of moving the boat comes from driving your legs against the foot stretcher and only then pulling the oar in. However, there are so many changes you can make to the stroke in order to be more effective: “speed up here!”, “slow down there!”, “be more deliberate about this!” These were all commands shouted across the water at some point by our coach. Simple in theory I reminded myself, yet every morning the stroke challenged me. Recently, I have been struggling with the ‘recovery,’ the moment when your body is almost still, compressed into your knees, with an almost four metre oar suspended in the air behind you. Instinct kicks in and I want to hurry the movement or drop my blade into the water for balance. Unfortunately, you have to get it right because ignoring the importance of that moment leads to less effective movement of the boat.

Embracing the discomfort in rowing has carried over to what I do after 6 a.m. – medicine. In my first year, I walked in to our introductory lectures with a couple hundred of my classmates.

We all shared the same overwhelming sense of excitement and anxiety of meeting new friends, which I had not felt since starting high school. In the first weeks I busied myself adjusting to the unfamiliar life of a medical student trying to decide what books to use, where to find a coffee fix, and mastering the concepts of a clinical examination. I was motivated to pursue excellence, but, in medicine that idea can be hard to define – especially as students. The sheer breadth and depth of information and clinical experiences can be so overwhelming that it can be hard to see the light at the end of the tunnel. But, more and more, in the last two years, I have come to appreciate that feeling of not having all the answers and the value of settling into the moment as part of my journey of learning.

34 Panacea

Acknowledgements I would like to thank the UQ Boat Club, the Commercial Boat Club, and the University of Queensland School of Medicine.

Photo credits to Tony Rush Photography. www.tonyrush.com.au

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36 Panacea

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Panacea 37

WORK/PLAY BALANCE: A PERSPECTIVE FROM ONE WHO FELL OFF THE SCALES Anonymous submission Medicine, I thought, should be my life. Beyond a casual penchant for binge drinking, I had nothing that took sufficient quantities of my time or interest that would qualify as a hobby. Consequently, I had nothing to support my flagging ego when I began to question my capacity to stand within the medical cohort. It all began in first year.

I joined a local football team, stoking the embers of a passion abandoned somewhere between childhood and adolescence.

I read, widely and only on topics that I found interesting. Most importantly, I began to socialise; at first with apprehensive effort, and later with genuine enjoyment. I did everything except actively seek to improve my uni results.

On superficial inspection, many of my peers looked like bright reflections of the platonic ideal of a medical student; intellectually gifted, confident, outgoing, vigorous and accomplished. Too aware of my own failings and busy exploring varied manifestations of sloth, I chose to keep my distance, and I spent the first few years of my degree as a willing (or so I told myself) inhabitant of the social outskirts.

And yet, my performance improved out of sight. Now, just months from stepping into a hospital as an intern, I have achieved a modest competency, and my anxiety, while not quite ‘normal’, is within the ranges of the typical medical student.

I was, simply and only, a medical student, unifaceted. My confidence, unshielded by growth in any other domain of life, was acutely susceptible to any academic result below my optimistic expectations. These insults began to accumulate, and I began to crumble.

Anxiety became the giant of my mental landscape, absorbing my attentions and mauling my confidence. My ethereal mind seemed to flee its earthly prison at the mere gaze of a consultant, leaving an empty, fleshy self mumbling non-answers to the simplest of questions. I further developed an already hypertrophied capacity for avoiding tutorials and ward rounds, and I was scraping through the course by the skin of my teeth.

Eventually, I hit a stark and awful place I can recognise now as rock bottom. Depressed and a keystroke away from giving up medicine, it was only strong familial support that allowed me to climb back to my feet. With a kind of resigned notion of “why not?” that can come to those who feel they have little left to lose, I began a process of self-construction.

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Mental resilience, I believe, is the most important trait a medical student can develop. The ability to absorb without wilting the quizzical gaze of a disappointed consultant, to profess ignorance to peers and superiors in search of answers, to plunge in a cannula after two embarrassing failures, this is resilience, and this is critical to how we learn in clinical years.

Play is a culturing ground for this kind of resilience. The wholehearted pursuit of our interests leads to the growth of a multifaceted self, in effect forming ballasts against the insults to ego that are a reality of daily life on the bottom rung of hospital hierarchy.

Enjoy your life, your future patients might just thank you for it.

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ENQUIRIES Please direct all enquiries about this edition of Panacea to Ming Yong at ppo@amsa.org.au.