Fear is the Enemy of Creation

Something I’ve been thinking of recently.

Is Fear synonymous with Perfectionism?

Fear of screwing it up?

Fear of not getting it right the first time?

Fear of looking like a fool (a usually unjustified concern)?

Fear you’ll launch and sell not one item?

Fear you’ll screw up your job interview and miss out on your dream job?

Are you fearing what others might say and think about your choices?

Does it really matter?

As long as you’re choosing something you’re passionate about, and believe in, by action you can convince yourself.

It’s all about learning along the way.

And acknowledging your fear.

Seth Godin says here to “acknowledge” the fear and shame. Don’t fight it. “I listen to it and do it anyway. And that is where we’re going to make the impact.”

It’s being mindful of it.

And recognising your power to conquer your fears.

What are you scared of most?

Is it really that bad?

Write down three actions you can take to challenge it.

Success At All Costs?

I touched on this briefly in my New Year’s post.

What saddened me when I dug deeper into medical startups in 2016 was that, quite often, success was seen as something to achieve at all costs, with no respect for customers, colleagues, or the wider community.

Even if a brand has a carefully constructed facade, it will all fall apart behind the scenes if you don’t genuinely care.

Coming from the similarly ruthless world of physician training, I found it very disappointing, especially when startups and the entrepreneurial world are trying to attract more clinicians.

Most clinicians are attracted to healthcare because of the caring aspect. They genuinely want to help make a great contribution to people’s lives, through direct patient-clinician contact.

That compassion and vulnerability can be misused by unscrupulous individuals and companies, and even with a strong Corporate Social Responsibility (CSR) program, the WHY behind the company can be lost.

Is any industry safe from this?

No.

But it’s up to us, the individuals, to keep our values in mind, and live them.

For real.

Are you living your Mission Statement?

Thank you, 2018 :)

It’s strange sitting here, 1.5 hours before midnight in my home city, 2.5 hours til 2019 in my current one.

But it’s a great time for reflection, particularly when you and your other half saw the Early fireworks as he’s oncall tonight.

2018 was a huge year for me.

One of my faves, Ariana Grande herself said it best- “I find it interesting that this has been one of the best years of my career and the worst of my life.”

I guess personally, it wasn’t the absolute worst it could have been for me, but it definitely had a huge amount of challenges that really rocked me- but also gave me the extraordinary chance to reset and reframe the difficult situations in my personal life.

You can dread each day and its challenges, or you can reframe it to be uplifting for someone else who’s going through a hard time.

Every day counts.

I really believe that, no matter what challenges your career throws at you, you and your loved ones come first.

They’re your anchor, they’re your reason, your “Why” in most cases.

And you should never be ashamed of putting your wellbeing first.

Because no matter how big your career gets- and I believe that your career is your startup - you’ll enjoy it more when you respect yourself.

If you need more time before saying “Yes” to a project, ask for it.

If you feel pressured to work weekends and public holidays because that’s “the startup way,” but you’re actually more productive just working on odd weekdays, go ahead and set your boundaries.

If your personal circumstances mean it’s more favourable for yourself and your family if you work a bunch of part-time and casual freelance roles, go ahead and do it.

If you feel your co-founder’s doing something dodgy, reassess and consider trusting your instincts.

If someone’s being two-faced, don’t be afraid to call it out.

If you love doing several other things along with medicine, allow yourself to do it.

Give yourself permission.

And many more examples like this.

Everyone will be better off for you owning your power.

—-

Someone wise I met recently gave me that wonderful piece of advice.

“Own Your Power.”

Own your decision-making capability, your strengths and skills, your relationships, your identity.

People will try to take advantage of your vulnerability.

So-called “friends” and “partners” in startups and medicine will show their true colours to you, even when the rest of the world can’t see it immediately.

It’s disheartening. It can be isolating, and you can question yourself and your perception, wanting to believe you’re wrong.

It’s okay, because questions are healthy, and I’ve learnt how valuable it is to be mindful, and become more self-aware.

It’s a great defence mechanism, mindfulness. I’ve found it’s a great decision-making tool, productivity booster, and mental health balm. (Ooh, I should package that! Next to the lip balm jars!)

But I guess my rambling here right now is to say,

THANK YOU.

Thank you, 2018, for teaching me even through my weaknesses and dark times this year.

Thank you for giving me the chance to grow stronger.

Thank you for helping me to speak my truth.

Thank you to every single one of you who stumbles across my page; who reads my articles from way back when; who follows and likes (for real) my stuff on social media; who has become a true friend from this crazy journey; who has bumped into me at some event or clinic somewhere around the world and said hello; who believes in me even when I don’t; who believed in me even when it doesn’t all make sense.

I can’t wait to share 2019 with you all.

Have a wonderful New Year and enjoy the celebrations :):):)

*I think I am serious about the mental health balm!

Doctors, You’ll Never Be Good Enough- And That’s Okay

First published May 12, 2017

Like many in the medical world, I’ve been deeply saddened by the suicide of a Brisbane gastroenterologist, the father of four children, the husband of a loving wife.

I don’t know them personally, but am touched by the email that his wife wrote and son sent online- which has triggered a flood of goodwill from his patients (the Facebook comments on the CourierMail post are so heartening) and from other health professionals and members of the public, who, like me, may not have known him personally, but felt devastated by this very unnecessary loss.

So what can we do? How do we stop others from thinking the only way out is suicide?

What’s the worst that could happen if you choose NOT to die?

Your patients may be looked after by other colleagues, or will find other specialists.

Your family will be concerned and worried about you, but they will be happier that you’re taking time to recover.

Your colleagues will most likely be concerned about you too, not mean-spirited. (If they are, why choose to work with them or choose to listen to them? What do they know about who you really are?)

Maybe part of it is our fear of delegating responsibility for our patients to others when we’re too crushed or sick to continue. Handover is so complex- even more as a consultant in private practice for many years. You would have built strong relationships with some of your patients who’ve grown with you; with your staff; with your routine. You would know their test results and the dates of their treatments off by heart.

And of course, when a patient dies, it is never easy.

Just because you’ve dealt with a patient’s demise or deterioration over and over again during the years, it doesn’t mean your feelings will be bulletproof forever.

And then, you also may fear delegating the responsibility of your struggles to others, to psychologists, to counsellors, to psychiatrists, or to a friend who’s a listening ear.

You’re good at curing patients. Why can’t you cure yourself?

You’re feeling enormous responsibility. Why burden others with that terrible weight?

There’s so much blame in medicine. We constantly want to be better. It’s the mark of a true professional, a craftsperson even in other professions. You want to better yourself.

But even doctors are only human.

Maybe we think it’s the absolute end, there’s no way out if we step back for a few days, weeks, months, years- it’s too terrifying at that moment to deal with the enormity of a future you don’t know.

We try too hard to control our futures and our patients’ futures, but as doctors and health professionals, and even startup founders, even we can’t control everything.

Maybe it’s time to recognise that and embrace it as something positive we can learn to live with.

But don’t do it alone.

Please seek help, no matter what your journey is.

Condolences and respects to Dr Bryant and his family. 

People may look like they’re doing okay on the outside, but are actually screaming for help inside. Please be kind to each other and ask directly, “are you okay?” 

Some useful sites/resources in Australia if you’re seeking help or contemplating suicide:

– Lifeline

– BeyondBlue

– Mens HelpLine

– Mindful in May

– R U OK? suicide prevention

– Victorian Doctors Health Program (please reach out even if you’re not living in the state, people are always happy to suggest other resources)

– your GP

– a psychologist

– a counsellor

– the AMA, which has other links to Drs4Drs which lists resources for Doctors in each State/Territory, and other sites; and the Australasian Doctors NetworkAustralasian Doctors Network which advocates for doctors’ health.

– Online video calls to a psychiatrist (you’ll need a GP referral but it is bulk billed)

– Lysn, a provider of online video calls to a psychologist

– your work’s Employee Assistance Program (many public and private companies including public hospitals in Australia, possibly in your country too, offer this free confidential service through external providers. The RACP also offers this, and probably other fellowship colleges do, too. Don’t be afraid to ask your HR or Workforce managers about this; it’s your right as an employee, and they are human, too, and know everyone goes through stuff.)

Feel free to list other resources you’ve found helpful below in the Comments. 

Highlights from HiNZ, Successes and Failures in Telehealth, and the Global Telehealth Conference Day 1

First published November 1, 2016

We’re Tweeting live from #HiNZ2016 in Auckland this week. Follow us on Twitter @themedstartup and @journalmtm, the Journal of Mobile Technology in Medicine. We’re also on Instagram @themedicalstartup.
Virtual tickets with HiNZ membership are still available at hinz.org.nz. 

What were some of today’s highlights?

1.Experiencing the Maori welcome ceremony. It was incredible seeing the haka and other traditional ceremonies performed to commence the event. Kia Ora!

Pic: The Medical Startup

2.Learning about New Zealand’s healthcare system. New Zealand’s DHBs (District Health Boards) manage the various hospital regions in the country of two islands, supported by the national Ministry of Health (MoH). With a large rural and regional population, their DHBs have managed to put together various digital health solutions to overcome the geographical, cultural and at times, linguistic barriers that occur. (We’ve written about what Australians are doing with telehealth here, and Dr Gregory Sam’s telepsychiatry service here.)

3. Discovering what sensor wearables can do for the elderly.
Professor Marjorie Skubic of the University of Missouri’s Computer and Electrical Engineering Department, has carried out extensive research into sensor wearables, inspired by her own journey to help her parents feel safe yet independent while living a considerable distance away from her. Gait analysis using Microsoft Kinect depth cameras; sensor mats in beds that measure respiration and heart rate; and other sensors embedded in the home environment are all part of her research, giving hope for the elderly to feel supported and independent while their children can continue work.

Prof Marjorie Skubic discusses Eldertech at HiNZ2016. Pic: The Medical Startup

4. Experts acknowledging that technology is a means to a human-centred solution for healthcare. As Lord Nigel Crisp of the United Kingdom said below during his address:

The Medical Startup@themedstartup

"Healthcare is a human contact sport" - Lord Nigel Crisp quotes his friend at @HINZ_NZ #hinz2016 @nhsdigital

8:12 AM - Nov 1, 2016

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Additionally, Homecare Medical, who won the tender for New Zealand’s National Telehealth Service, understand that citizens don’t expect healthcare to be limited by geographical boundary anymore.

The Medical Startup@themedstartup

"The Virtual world doesn't respect the boundaries of District Health Boards (&other local health systems)" Andrew Slater, Homecare Medical

9:27 AM - Nov 1, 2016

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This leads into the topic of Precision Medicine & Personalised Medicine. As technology evolves, patients will feel more empowered to take control of their healthcare (as they already do by Googling symptoms and performing other forms of accessible research), and clinicians will have to evolve to understand their patients’ perspectives better. Patients will expect medicine doses and timing to be tailored; their leaflets or apps about their conditions will  be personalised; and more forms of personalisation to enable better living.

5. Learning what Clinicians think of Big Data. Big data is important, but what good is it if it’s of no use to you in future? With big data comes big responsibility, and collecting unnecessary data wastes valuable time and resources.

jMTM@journalmtm

"I thought Technology would be v important with all this,but it's actually Change ie.human behaviour-"Prof Chris Bladin @TheFlorey #Hinz2016

8:46 AM - Nov 1, 2016

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– above quote from Prof Chris Bladin when presenting his journey as a neurologist with the Victorian Telestroke program, which has successfully treated rural and remote patients throughout the state. They’re now looking to expand to other States.

The Medical Startup@themedstartup

"Elective #surgery is a great target for #bigdata but you need #goodquality data"Dr Mark Fletcher #anaesthetics #registrar#hinz2016 #ehealth

11:11 AM - Nov 1, 2016

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6. Watching the Finalists of the Clinicians’ Challenge, supported by New Zealand’s Ministry of Health. It strikes a chord with us that a national government supports and empowers their clinical staff as innovators, being the ones at the coalface of medicine. Finalists include an Anaesthetic Fellow; a Pharmacist undertaking doctoral studies; a Public Health doctor; and a Junior Doctor working in Dunedin. Stay tuned for further details, as well as updates on last year’s Ophthalmology and Surgical winners.

For more information on HiNZ, visit hinz.org.nz.

Interview with Dr Gregory Sam, Psychiatrist and Director of Conduit Health: Part 1

First published April 26, 2016

 Dr Gregory Sam is a consultant psychiatrist who founded Australia’s first bulk-billing telehealth psychiatry consulting service, Conduit Health, in 2014. Focusing particularly on rural and remote communities, Greg currently runs Conduit Health along with his private practice work in the city. In this three-part interview series, Greg kindly shared his tips for success, the road to Conduit Health, mixing business with medicine, and rising from failure.

Image credit: Dr Gregory Sam

How did you get the idea for Conduit Health?

I think the idea started during my rural rotation of training in 2009. It was often a whole-day affair to see these clients, 4-5 hours’ trip each way, and that was disheartening to see people suffer so much. It’s supposed to be easy access. But they had to wait ages before seeing a psychiatrist.

So I aimed to fill that gap.

I started because I was so frustrated at the way things were.

I found so many deficiencies in rural mental health care, and thought, how do I improve things? There area lot of difficulties and shortcomings in the system. I was always into tech stuff. So I tried to think of the amalgamation of the healthcare and mental health care sectors. Telehealth was in its infancy then. So I thought, why can’t we assess the patient through telehealth conferencing?

I struggled to get through my exams, failed 3 or 4 times, and started to get a bit disillusioned about my career in general. I wasn’t sure why I wasn’t getting through. A lot of thoughts were going through my head. Is this the life for me? Should I be changing careers? A whole heap of stuff. But I thought, there’s still good things I can do in this field, whether it’s as a registrar or consultant or not. I’ve learnt a whole heap about my specialty through this. 

How long did it take you from having the idea to taking action, alongside your clinical work and studies?

Honestly, a few years. My idea has been since 2009, and it’s very tempting to get distracted by training. I was so focused on training that all these other things I could do fell by the wayside. I had the idea for a few years, but only started something solid in 2014.

I think 2014 was when overcoming all the inertia of starting a business occurred, planning and actually doing things. 

Failing my exams gave me that opportunity to start thinking outside the box. I took 3 months off work to have a break. I think that’s the best thing I did during training. I focused on badminton and other things I like doing, and started to make moves on my company. I had meetings with colleagues and friends in business, picked their brains, tried to absorb as much as I could from them, both guys and girls, to understand what it’s like to get into business. My business friends said, “it sounds like a brilliant idea, why don’t you do something about it?” So that gave me a kick to start.

When I went back to work, I left business for awhile and focused on passing exams. Once I passed, during our year of Advanced Training, I set learning goals on things like, “I want to learn more about drug and alcohol,” and other goals which I did in my day job, and also focused my energy on Conduit Health. That’s when the wheels started turning.

2015 was the launch date. Our first consult was February 2015, so 2015 has been a big year in that it’s a startup, and for most startups it’s about sustaining that growth, so 2016 is another big year. A lot of planning happens with regards to how to continue that growth, otherwise it’s too tempting to have a firework effect where it starts then fizzles up. 

Overcoming inertia is hard, but once you overcome it, things start rolling, and you can’t stop.  It’s a lot of commitment but so rewarding, more rewarding than my day job. I find treating patients rewarding, I can help them and their families as a psychiatrist. Whereas with Conduit Health, I’m helping so many more people across the country. We’ve had referrals from far and wide, from every state, and remote locations like the Kimberley and the Great Barrier Reef. I’m working with primary health networks (PHNs) across the country to expand our reach. 

How does a typical consult run?

Conduit Health, Telepsychiatry Service. Photo courtesy of Dr Gregory Sam.

Either the psychiatrist dials in (from their location), or the patient (who’s hosted at their GP clinic) dials into us, then the psychiatrist introduces the consult. We need to say at the start that we’re doing it via teleconferencing, that there’s no one else in the office, and check who’s in the office. This sets the scene so the patient can understand that there are no unseen people in the room. We discuss confidentiality, unless risks in which case we need to notify particular people. It’ll go between five minutes to an hour, we state our aims, then start the diagnostic interview.

The video quality is quite good, but if there’s any lag or dropout, we disconnect and call back. We check at the start, “can you see me? Can you hear me?” We check camera position so the webcam points directly at the patient and so the patient can see us. We also make sure it’s appropriate, eg. the psychiatrist is in a quiet isolated room, not at the beach. We set rules for our psychiatrists. They use the Conduit Health backdrop. 

Sometimes a mental health care nurse will be there. We offer to GPs, if you want to be present for the whole assessment or in the last 5-10 minutes, you can. Some GPs stay for the whole interview, others come in the last 5 minutes and ask the psychiatrist, “what’s your diagnostic impression and what’s your plan?” They can get immediate feedback, (and sometimes help with scripts and so on).

We also get constant feedback from other GPs. My role is partly to ask patients and GPs, “how are you finding the process? Can we make things better for you?” Constantly evolving the company.

One benefit of Conduit is confidentiality. You don’t need to go into a psychiatric facility where everyone knows it’s a psychiatry facility, and sit in a waiting room with other mentally ill patients. Patients have said that’s a benefit, so people don’t have to know they’re seeing a psychiatrist. In a way that’s also bad. We’re not trying to promote stigma of mental health, but unfortunately this is a barrier to receiving care.

How did the name Conduit come about?

I was building a house at the time, and working with the builders, one said, “I want to dig a tunnel under your garden to create a conduit for your electrical wires to go through.” Also from my cardiothoracic surgical rotation in med school, “they harvest the conduit” in bypass surgery, and they explained what a conduit was to me. I then thought about what Conduit Health does, it takes away big distances and gaps.

The logo is a bridge, to embody bridging gaps.Suddenly, 300 kilometres to go to an appointment doesn’t matter anymore. It’s a link, a conduit, from point A to B. So patients don’t have to travel.

I don’t think telehealth will replace traditional face consults, but it can address geographical barriers.

Would you expand Conduit to non-psychiatry services?

The immediate next need would be psychology. It would be great to have psychologists who can do tests and consults. But at the start, I want to focus on psychiatry. Some companies have one of every specialty, but I want to focus (for now). If there is demand later on, for say, neuropsychology, social work, we will expand to fill the need.

What about your plans for aged care?

A big arm we’re developing in 2016 is to work with residential aged care facilities. There’s such a huge need, patients can’t often go see a psychiatrist. Aged care services are often floundering, “can we get the psychiatrist to come here?” but not many psychiatrists want to do that to see one or two patients, it’s not feasible. But we can go in and have a session there, and it’s immediate. So 2016 will be a big year for Conduit Health Aged Care branch. We want to expand to all the big aged care facilities. 

To learn more about Conduit Health, click here. 

Stay tuned for Parts II and III of Greg’s interview, in which he discusses his business inspirations, his insights on failure, and running a business as a medical professional.