Recording Podcast (Victoria Lister) with Sharee Johnson
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Sharee Johnson: Today it is my honor to be introducing you to Victoria Lister Victoria is a researcher and a doctoral student under examination in the Griffith Business School in Brisbane, Australia. Her PhD investigated the powerful occupational forces that prevent junior hospital doctors from speaking up about their working conditions, a topic that she is now very passionate about, and I join her in that passion and that has led her to the realization that PhD candidates undergo a parallel process like junior doctors of simultaneously being tested for suitability and groomed for entry into an elite and highly competitive profession with special rules that are not necessarily made explicit.
As a result, she has expanded her research interests to doc doctoral students and early career academic voice and silence, and their mental health and wellbeing. [00:03:00] Victoria is also a qualified workplace coach supporting new and early career professionals in academia, medicine and nursing, and is currently researching and delivering a coaching for communication program for emergency medicine clinicians, which she'll also tell us about.
Prior to academia, Victoria worked in hospitality advertising and in the not-profit, not-for-profit sector. She has owned and operated at least a couple of small businesses, and she continues to consult to not-for-profit organizations on health and on healthcare professionals wellbeing and workplace safety.
We have a lot to talk about. Welcome, Victoria.
Victoria Lister: Thank you, Sharee.
Sharee Johnson: It's uh, it's really super that we found some time together pretty quickly, so I'm very grateful to you for that. Thank you very much.
Victoria Lister: You are very welcome.
Sharee Johnson: As we've started each of these podcast conversations, I wonder if you would tell us a little bit about your current working life.
What does it look like in the ordinary, you know, week or month of Victoria Lister at the moment?
Victoria Lister: Mm. [00:04:00] A bit of a juggling act. More recently it's been about completing the PhD. So there was a, probably a three month period from around Christmas time to mid-March where it was nothing. But, so a lot of things got, got relatively sidelined work things and life things.
So there was a period of playing catch up after that. But I'm back into a rhythm now, of doing other kinds of research work that I've been doing for. A little while now, couple of years. So one thing you do in academia is build a pipeline of projects because it takes a long time to, to do research, and it takes a long time to publish your research findings.
So you need a, a steady stream of, of projects that you have on the go, that you work on [00:05:00] over long periods of time. I mean, some of them turn around quite rapidly, uh, relative to others, but others don't. You know, I have one which is a two year project, and that'll be wrapping up at the end of June.
Others are much shorter, but academics are very time poor people, especially the ones in tenured roles who are teaching. They have a lot of work in relation to teaching and it's hard for them to find time for research. I'm in the position where I, I don't have a tenured role. I have a, a string of casual or sessional roles.
So essentially I'm a freelancer and I tend to focus on research rather than teaching, which research is my main interest. Yeah. So the week is very, uh, mixed in terms of what can happen in a week. Sometimes it's hours and hours and hours of time in front of the computer, analyzing data, et cetera.
I prefer the days [00:06:00] where I'm doing things like this, where I have meetings with actual people and I'm not just communing with my computer and, I like having a multiplicity of projects to, to work on. I find that interesting and it, it keeps things fresh, which is why the PhD is quite a, difficult task.
'cause it, it does go on for a long while and it's essentially a solo project.
Sharee Johnson: I want to congratulate you again. I think it's a real exercise in persistence and, it seems to me as an outsider, and I could be totally wrong, but it seems like it's a lovely, outcome to find that you're actually passionate about what you're studying.
That the inquiry that you found yourself, , engaged in was interesting to you. Please tell us a little bit about your PhD.
Victoria Lister: Yeah, look, I came to it very serendipitously. I was actually working as a research assistant post having completed a master of philosophy, which is a master's [00:07:00] level thesis or research degree. Then COVID came along. Mm. And that put the kibosh on that particular project. So I, I lost that job and I thought, oh, I still wanna hang out in the research space. I'm, I'm just getting to understand really what this is all about. So I kept an eye out for research oriented roles and I saw an add on Seek one of our common, job seeking platforms here in Australia that was for a PhD scholarship in employee voice in healthcare.
I thought, oh, I'd heard of employee voice. I don't know much about it, but it sounds interesting. Healthcare, I don't know anything about really. Anyway, I applied for it and I was successful. So I was, I guess thrown into a world that was quite new to me, even though I investigated other research topics [00:08:00] in the business and management discipline, none of them centered around the concept of voice, et cetera.
And it's, its twin, which is employee silence, which is the area I ultimately became very interested in and focused on, uh, primarily because silence is the far more predominant, um, phenomenon in healthcare. People tend to be far more silent at work than they are vocal. And that was to me, the thing that demanded attention.
When I looked at healthcare professionals, frontline healthcare workers, and this is in the hospital context, I became interested in junior doctors specifically because for a couple of reasons. One, they are key people in the delivery of medical services in hospitals. It's very [00:09:00] hard to pin down exactly what percentage they form of a hospital workforce.
Um, but I, I think at least over half of all doctors or junior doctors work working in the hospital context, perhaps as high as 70%. Mm-hmm. But they, they are in fact the workhorses of the delivery of medical services in hospitals, but because they're newcomers, they're also subjected to a lot of different pressures that are particular to their, their junior status and their status as new professionals in the medical profession.
I found that very interesting. An additional factor was that as doctors, they nominally top the medical, well, the healthcare professional [00:10:00] hierarchy in hospitals, but they're quite influential people. Even though junior doctors are not necessarily influential, until much later on in the, the training, if they're going down that specialist path.
But as newcomers, they're also vulnerable, therefore, to silencing. They're also much more aware of it or can be. Um, but I argue in the end result, they're actually not that aware of it. Some are, many aren't, um, because of the pressures of their role.
Sharee Johnson: Hmm, hmm. I think that the general, research into voice says that people lose their voice at work very rapidly.
They only need one or two experiences of being silenced to lose their voice. So I think we can dig into that quite a lot more. Before we go there, Victoria, will you tell us a little bit more of your backstory, because you've really done a lot of different interesting things outside of health and I wonder how that helps you in your question making of health that, you know, you've [00:11:00] got these other reference points.
You just told me before we started that you, left school, went to university, and then left university to become a chef. So maybe start there. It's very interesting in terms of recalibrating.
Victoria Lister: Yes, true. So I was one of those who left school not knowing what they wanted to do.
Didn't enjoy year 12, but managed to scrape into an arts degree at Sydney Uni. So I went off and attempted that and I, I, I did that for two years. Gradually losing interest, dropping subjects and finally left. I couldn't stand it, seemed to me to be a continuation of school. I felt like I was hanging out with the same people I'd been at school with.
I did meet some new people, which is great. It didn't feel practical to me, so yeah, I left and went and did well, something supremely practical. I, took up an apprenticeship in commercial cookery, which is what qualifies [00:12:00] you as a chef. And, that, that was a very interesting role or series of roles 'cause I didn't work for the one employer. I worked in pretty good restaurants in Sydney. I'd come from a foodie background. I had foodie parents, so I knew a little bit about food and had an idea of the kinds of places I wanted to work in. It, it, it contrary to what we see on tv, uh, I actually found it a fairly benign, occupation in terms of things like bullying or harassment and so on.
I know that's not everyone's experience, but there's a piece of about hospitality, which is about bringing lots of different people into the fold. So, particularly in Sydney, a lot of people who work in hospitality are, [00:13:00] for example, gay or lesbian. So you've got quite a mixed crowd from the get go.
They come from different places. It has a sort of vibe, that's a little less staged than other kinds of occupations perhaps. And I actually really enjoyed most of my kitchen experiences. The, the harder things for me were more the physical aspects. And so it, they're very hot. There's a lot of heavy lifting. You get burnt a lot. You get lots of cuts. Um, and you have to deal with the pressure of, uh, in a busy environment, constant orders coming in. And that can be really tricky in, in some areas of the kitchen. I, during that time, I also established a small food business. So my then [00:14:00] partner was also a chef. We were both apprentices.
We, we were earning around. I remember I was on $120 a week.
Sharee Johnson: Wow. Yeah.
Victoria Lister: Uh, so we thought, what can we do to, to earn extra money? Foolishly we decided to start a small business, which doesn't always earn a lot of money, but it, it was a wonderful learning experience and we were able to take that enterprise. We were manufacturing gourmet foods. Um, we started with a small range of jams and a marmalade and expanded over time to, uh, pretty much anything you could put in a bottle. And it was at the time where sun dried tomatoes were hitting the culinary scene. So we, we were, working a lot with, with sun dried tomatoes. We had a range of chocolate and caramel sauces. We had vinegars and oils and, um, [00:15:00] we, we took that to quite a reasonable level. It became a, a large-ish cottage industry. We earned a living from it. But, you know, we didn't, we didn't, we weren't in the big time. Put it that way.
Sharee Johnson: You didn't, you didn't get to sell it to Heinz or something?
Victoria Lister: No, no, no, we did not. Um, people copied some of what we did, that's for sure. 'Cause we were front runners at that time. There were very few local gourmet products on the market. So we're talking, um, mid eighties here. We were selling into places like David Jones, like Myers, uh, uh, upmarket delis, and then ultimately partnered with a food distributor who was able to take our, our products even further.
So we, we were in a small factory by the time we both exited the business.
Sharee Johnson: Did it, did it meet your need? You know, you were at university thinking, there must be something else. I could do [00:16:00] something else and I could certainly do something more practical. And so, so you had that, that, that adaption or that change that reorientation into, into the adult world doing something else, did it meet those needs?
Victoria Lister: Look, it did, it did. Uh, you know, cooking is a, a very, it, it's an interesting trade. Uh, obviously there's a lot of practical skills that you need to learn, but there's a science to cooking as well. Um, very much so. And then there's, there's the visual elements of, of putting together dishes, et cetera. So to me that was very satisfying. The food manufacturing business, ultimately less so because that is very process oriented and you end up doing the same things over and over, so that can get a little dull.
Um, and [00:17:00] that's pretty much where I landed at the end of it. It was like, yeah, I think I'm done here. Um, it, it's been creative, you know, the act of cooking is creative, developing products is creative, and I have that as a strong streak in me. But, , once you get to a certain stage, you're, you're literally, repeating, processes over and over.
Ultimately I left there because I actually wasn't intellectually satisfied enough.
So, uh, another serendipitous sort of event occurred where two people who knew me quite well independently suggested I consider becoming a copywriter. So writing copy for ads basically. And they knew I was reasonably skilled at, you know, writing and whatnot. And so I did. I, I [00:18:00] trained in North Sydney with a wonderful woman who had been quite highly regarded in that profession or occupation. Um, and then I started out in radio, which was her first love as well. Radio's a wonderful medium to work in, uh, because you are, you are running scripts in your head.
Everything you read, you hear. I don't know if people are aware of that. When you're reading, you, you tend to hear it in your head, and when you listen to ads, it, it sparks like a, a little mini play in your head. You visualize what's going on. I mean, not only ads, but if you hear a radio play, that can be a very rich experience.
So the best kind of audio ads are mini plays that leave a strong visual impression in your head. Are they, the impressions you want to receive is another matter, [00:19:00] but working in radio first up, and I did it for free, was amazing. I loved it.
. So I worked with a group of people who were ex Triple J and was setting up radio FBI, which was ultimately successful, the successful bidder. . We, we ended up on air for three months in a row and I had so much fun. I had complete creative freedom. We didn't have advertisers, we had sponsors who were supporting the efforts of the nonprofit that was behind the station, and of course, great people to work with.
Amazing. I had an amazing boss, um, and, and super fun colleagues, and I learned a lot and I loved it. Yeah.
Sharee Johnson: So I'm wondering, already listening to these experiences of what's happening now in your understanding of the world about not-for-profit, about [00:20:00] sponsorship, about, teams. All of these, , I think we, we forget sometimes when we get further along in our careers that these early origin stories that really have us orienting in the world in particular ways or that open up new opportunities or new understandings for us.
When you look back now, can you see things from that time that you still relate to in, in your work?
Victoria Lister: Yes. I mean, most particularly, I, I did end up after radio, working in advertising agencies. Two, two of them. Um, which is a very tricky thing to do.
It's very hard to get into, every man and his dog wants to work in an ad agency. Um, and yet I didn't stay there. Part of me wishes I had because the creative aspects of that kind of role [00:21:00] are wonderful. It's, it's a lot of fun. I mean, there's a lot of crazy stuff that can go on behind the scenes, but the actual job is really interesting.
And I worked in an area of advertising, which was what they call direct and integrated marketing. So it tended to be more long copy advertising, not short, 30 second or 15 second ads on radio or tv, but longer, more persuasive, forms of copy. Uh, well, any creative brief is wonderful for getting your head around a business. So those kinds of experiences have been invaluable and, and working with art directors and graphic designers, um, has really honed the way I think and, and do things as well. Uh, so wonderful, wonderful experiences.
But where I landed was I ended up in an agency through a merger that I hadn't had any prior interest in working in, [00:22:00] and I didn't feel at home in that culture. And I reacted to that. I survived the merger so I could have stayed and had a very fruitful career. And that's a part of me that wished I had. Um, but I went into reaction around what it was I was being asked to do and who I was working for, there was a part of me that felt this isn't right. I don't feel at home, promoting credit card spend at Christmas time when I know that people can't, uh, afford credit cards, let alone accumulate masses of debt.
And coupled with the person I was now working for, I thought, I'm gonna leave. And I found out not that long thereafter, perhaps that the industry I then [00:23:00] left for, which was the nonprofit sector was just as problematic as the for-profit sector. So that was a massive learning, and you could say recalibration for me.
Um, though I've been through a few, every time you change industry, there's a lot to, to take on and learn about it, let alone the craft skills that you're learning. Um, so yeah. I hope that answers your question.
Sharee Johnson: Do you think, do you feel like all those different parts, the uni, when you were a chef, you were at tafe, then the, the smaller, uh, advertising businesses and then the bigger , the merged business and, your side hustle, which you haven't mentioned that you have a current side hustle as well, which maybe we'll just put that in too.
Do you feel like all these different experiences built on each other, I guess, do you feel like that, that you now have this sort of rich texture, lots of perspectives to how the world of work and how people in the world of work can be.[00:24:00]
Victoria Lister: Absolutely. And I, I think that's the common thread. I mean, there's no rhyme or reason to the, the career choices I've made when you look at the things that I've been doing. But yes, there has been an ever present fascination with, with the world of work. And when I went into the nonprofit sector, it was initially as an employee, I worked for a disability employment service.
So organizations that support people with disabilities to find work. So it's very much about understanding what, what people are interested in, um, where they can be placed in this instance because of their, , um, limitations. Uh, so yes, and everything that I've learned along the way has involved business, has involved organizations, be it larger businesses, corporations, um small [00:25:00] enterprises, micro enterprises like my own. And yeah, now I'm in for the moment at least, academia, in business and organization, and management in, in that discipline area. So, um, there, there's no surprise I grew up with parents who were entrepreneurial. My father was a serial entrepreneur and a successful one, that to me was normal.
And, and it was interesting as well. My mom pitched in, she was a creative and she pitched in, to support them in their early years by using, drawing on her artistic skills. She trained as a sculptor. So, there was an amazing sort of influence around me that I just took for granted and felt very at home in and ended up expressing those aspects myself.
Sharee Johnson: I think it might be interesting, your story, Victoria, on a number of levels, but one of [00:26:00] the things I'm noticing just now is the contrast between certainly, doctors in training and I, I think from some of the things you've said in academia as well, these train tracks some of our doctors get on, particularly the ones that come straight from uni. Sometimes they do -bio-med or something else, but essentially they get on the training to be a doctor track and then they, go into hospital for a couple of years.
Then they get on the training program. You know, there's a long time of investing in this same process. The next step, the next step, the next step, the next step. And there's a real contrast in what you've done, where you've taken some twists and turns and, and there hasn't been a clear linear process.
So I, I really like that for our audience, this contrast that, um, sometimes I think when we are in one industry, we forget that the rest of the world doesn't necessarily operate this way. And so you are providing a really nice example of how, you know, people have very successful, interesting careers that have twists and turns in them so thank you for sharing.
Victoria Lister: Absolutely.[00:27:00]
Sharee Johnson: And, and just to tick off that bit about what's the current side hustle, I can hear some of our listeners going, so what is it, what does she do? So do you wanna just speak to that briefly?
Victoria Lister: Yes. About 10 years ago, I realized that I wanted a product that wasn't available on the market.
Or perhaps more accurately had just come onto the market. And I'm talking about, uh, if people remember the brand, Spanx Shapewear. And this was sort of a new thing, probably it's been in America or elsewhere longer, but it was new to Australia and at that time I was starting to feel I need a garment that is, is like a bike short as, as a piece of underwear.
So it gives it a good coverage on the thigh, but isn't made of Lycra [00:28:00] for obvious reasons that women will appreciate. I couldn't find anything. And the likes of Spanx were sort of synthetic compression bandage type material. And I, I remember trying to put a pair on in the change room one day in a department store.
And I couldn't get them past my knees. It was like, oh, this is not what I wanna be wearing, not what I want. Yeah. And I knew that other women felt the same and they were going to things like bike shorts to solve a problem, to solve a particular problem. So I'm talking about women with larger thighs who might experience chafing or, or just want extra support on the thigh rather than wearing a brief underpants.
So I didn't know anything about, um, the world of fashion. I hated sewing all of that. But I [00:29:00] had a, a, an idea in my head of what was needed. I started working with a friend who was a seamstress, but she was perhaps more oriented towards fashion rather than the more utilitarian pattern making, that it turned out I was actually after, and by this stage, I was, I had returned to university. And I'd met a woman there who's designing plus size lingerie. Mm-hmm. And I spoke to her and said, how are you doing this? Did I have a pattern maker? I'm like, oh, can I meet this person? And that's how that evolved. So, I started with this pair of what I call longer pants, long-legged underpants, made out of super soft material, stretchy, breathable as few seams as possible.
And it's, it's expanded over the years to about six [00:30:00] different items, active wear mostly. Do you want to say it so that people can we'll put it in the show notes as well. Yeah, sure, sure. Hummingbird Pie.
Sharee Johnson: Hummingbird Pie. Awesome. Okay, let's move on now to your actual research, and thank you for giving us that backstory. I think it's just really rich in variety and, it's a beautiful example of psychological flexibility and how we can, imagine ourselves having lots of different identities and imagine ourselves in new places, in new roles and, and doing new things.
So thank you for taking the time to give us some of your backstory. It's so interesting we could spend the whole time chatting about it, but I think our audience probably want to hear about your research and I want to give a chance for that too. So. So you've been studying young doctors, who work in our hospitals here in Australia and in particularly, you've been really inquiring what is it that helps them to speak up?
What is it that silences them, and what's their experience of that? So can you give our audience some summary or some indication of what you've learned about, about [00:31:00] this idea of voice and silence for young doctors?
Victoria Lister: Yeah, look, I'll, I'll start by describing what voice and silence are in the work context.
Great. So, yeah, 'cause it is a specific thing, even though we, we can talk about these concepts generally. So employee voice is employee's ability to speak up at work about issues that interest them as employees or concern them or about issues, suggestions, ideas that might be of interest to their organizations.
So you can have employee voice being an employee focused phenomenon or an employer focused phenomenon, or ideally both. That's called integrated, an integrated approach to voice silence is the obvious flip side of that. So it, again, it's specific. So silence about issues that [00:32:00] concern you or the organization.
Employee silence is the flip side of voice. So it too refers to work related topics, things employees might want to speak up in regards to their own working conditions, for example, or in the healthcare context, patient safety.
Or it can be silence about things that, interest the organization, which again, in the healthcare context would be more to do with patient safety. 'cause that's a concern for organizations. So it's considered difficult to understand 'cause it's essentially the absence of something. How do you study that?
But it is, it is quite simple to study in that you just simply ask people about their experiences with not being able to speak up at work and what that [00:33:00] is like and what motivates them to not speak up. Why, why do they, um, decide to choose silence? Do they in fact choose silence or is it chosen for them?
So that's the the question I became interested in for one of them. The silences that I focused on related to working condition silences. The literature that is out there primarily focuses on patient safety silence in the healthcare context for obvious reasons. It's, well, it's a fundamental to healthcare patient safety, but it, it's also a massive problem.
The lack of voice around patient safety is a really, really big problem. And it's been that way for a long time. It was identified as an issue around, the turn of the millennium in [00:34:00] terms of research and has fostered a lot of research since. But no one seems to be able to know how to solve it, what to do about it.
There've been many, many interventions. Um, and as far as I can see, none of it has worked. Very little. Very little of it has worked. So I became interested in why, why was this the case? And I specifically honed in on silences around working conditions because they, working conditions, concerns are even harder for healthcare professionals to voice because they're generally second in the equation.
So patients first, of course, but hang on, where's the healthcare professional in that? So their own working conditions concerns get [00:35:00] sidelined. Having said that, if healthcare professionals are unlikely to speak up for patient safety, they're going to be even less likely to speak up about their own working conditions.
So I felt it was very important to, to bring a focus to this other area of working conditions, which has been largely overlooked. Mm. And junior doctors I became interested in for the reasons I stated before, I call them junior doctors 'cause not all of them are young. I, one of my participants was in her mid fifties.
Uh, she trained as a, a nurse and very, very senior nurse and had worked as a nurse for many years and then decided to become a doctor. So there she was, you know, going through internship and residency in her mid fifties. And there was some older people as well, not, not quite in that age bracket, but on the more mature [00:36:00] end as well in, in my sample set.
Sharee Johnson: And so what, what did you find, Victoria? What were the junior doctors telling you about their experience?
Victoria Lister: Overall, their working conditions concerns, uh, I hate to say this, but outweighed their patient safety silence concerns. And this is, this to me, is understandable. I mean, in their hearts, they are definitely, definitely wanting to speak up about patient safety issues.
But the things that affect them day to day are their working conditions. And in the junior doctor space, um, those working conditions are often very overwhelming to the extent that they then affect patient safety. So I, I'm not telling anyone anything new here. If, if you are a doctor and you're listening to this, but the literature hasn't understood this or [00:37:00] focused on this, which seemed to mean an extraordinary omission.
Uh, and I wanted to know why, again, why, why, why this mysterious gap. Uh, when it seems quite obvious, and someone like me who's not in healthcare can walk in, read the literature for six months and go, well, hang on. This is missing. This is missing, this is missing and this is missing. But there's an explanation for that too, which we'll probably get into.
Sharee Johnson: Please tell us now. I'm dying to know.
Victoria Lister: So, so what I then did was focus on what was also missing from the literature. So it was well established that professional factors, , have a large part to play in patient safety, silence. 'cause that's where the literature was. The small amounts of literature that had focused on working conditions also identified professional factors.
And what I [00:38:00] mean by that is what I then started to call factors related to occupation. So if we peel that back a bit, a professional is a type of occupation. So if you look at the, the standards for, for considering occupations, managers is one, professionals is another, trades and technicians is another, and so on and so forth.
So I started to think about the occupational. What were the occupational factors that were interfering with people's ability to voice? And as I said, some of these had been identified and it has been identified in the literature that healthcare professionals are hamstrung by certain aspects related to their occupation, such as the hierarchy that's [00:39:00] present in their occupation. It could be the ideologies, the occupational ideologies associated with their occupation. And I started to see that this was particularly the case in the medical profession, which has a very strong, culture around it. Very powerful ideologies that permeate not only the medical profession, but society itself.
We have a lot of societal mythology about doctors, um, beliefs about doctors and who they are and their status and their standing, and so on and so forth. I essentially got to the point where I couldn't get the answers I wanted from either the management literature or the health literature, which is the two areas I'd been [00:40:00] focusing.
So for answers, I had to turn to the sociology literature or not had to, but that's where they were. There's a whole strand of sociology called Sociology of Professions. And the medical profession features quite prominently in studies, because it exemplifies the kinds of things that, uh, that, that impede and, construct social groups and that particular social group.
So there was explanation there for how occupational groups in the professions. Form themselves, why they behave as they do. Well actually, not necessarily the why that came from a separate strand of literature, but they certainly, there's been a number of scholars over the [00:41:00] years who've looked at the professions and particularly the elite professions.
So when we're talking elite professions, it's medicine, law, divinity. In the first instance that was in the Middle Ages when those three, uh, came to prominence over the years, that's expanded. Divinity has dropped off. Um, so we now have, uh, architecture, accounting, uh, laws obviously still a part of that and other professions that have emerged more recently.
But the elite professions in particular behave in certain ways that secure their, their status. That set the tone, if you like, for what that profession is. Carve out spaces, their social spaces, first and foremost. So they carve out spaces amidst the, the broader social environment and declare certain things about themselves and that they do certain [00:42:00] things and that they have certain knowledge, which is then transferred typically through university education.
They also behave in quite aggressive ways. So this, this sort of boundary setting or carving out of territory can lead to quite interesting stoushes between different professions. Uh, each claiming their space, sometimes trying to intrude into the other's space. We see this a lot in the medical profession with the ongoing debates around cosmetic surgery versus plastic surgery.
Um, there's been,
Sharee Johnson: well, I'm thinking just now of the, uh, the policy shift with the government between what pharmacists can do that Yes. Would be traditionally what general practitioners would do. You know, I think that's a good example of what you're talking about.
Victoria Lister: Absolutely. And nurse practitioners.
Sharee Johnson: Mm-hmm. Nurse practitioners have a much [00:43:00] bigger role in New Zealand than they do in Australia at the moment. Exactly. Interesting back things, these boundaries shifting or, or challenges or seen as seen as a boundary challenge, they may or may not be meant to be.
Victoria Lister: Yes, yes. Well, I mean, the degree to which they're aware of what they are doing is, is debatable, but it is definitely protectionist in its sort of intent where we're protecting what we do, and we have good reasons for that. We have patient safety concerns, et cetera, et cetera. Um, but when you view it from a helicopter view, it's, it's quite an interesting, uh, theme in that it, it's quite combative. And one of my arguments is that this sets the tone for how the profession is.
There's, there's these sort of chess forward moves being [00:44:00] played out at the, the highest levels that then arguably trickle down or influence the ethos or the, the culture of that particular occupation. So I, I hate to say this, but the medical profession is often drawn upon in the literature as an example of a particularly aggressive profession.
Um, and, and you can see from how we think about doctors, how we think about medicine, that it does occupy quite a significant, um, place in the hierarchy of, of professions or occupations more broadly. And how we think about doctors, as I mentioned, generally.
Sharee Johnson: Certainly we, we see that in parents of high school students, don't we? We see, you know, yes. So and so wants to be a doctor or a lawyer. There's, you know, sort of this ripple of regard that goes around the whole community about this bright student who's gonna be an engineer or a lawyer or a doctor. I hear [00:45:00] that, I dunno if you are hearing that in your work.
I hear that with the people that we are coaching, that they're often concerned if they change course or if they do something different, from the medical train track that I was referring to before, that they'll let down so many people that the other people are invested in their, admission, if you like, to use the, the kind of phrases that you are thinking about, the admission into that profession.
Victoria Lister: Yes, that I found that too, in my research, and I, I've heard it in some coaching conversations and general conversations as well. Um, and certain cultures, , certainly placed a lot of emphasis on, you know, their children being doctors or lawyers or what have you. And that came through as a theme as well.
Sharee Johnson: Victoria, can you come back around to the, the, I guess the themes or the conclusions that are coming from your work with junior adopters about voice and silence? Are, are there things that are, there pointers? Are you [00:46:00] finding things that we can work towards to help our junior doctors, given the deep hierarchy and the things you are describing about competitiveness and so on in the medical, world?
What, can we do? What, what are the things that can help our junior doctors have more voice?
Victoria Lister: Yeah. The, the main thing I believe needs to happen is that senior doctors need to, lead on these issues. Because they, at this point, particularly if you go into specialist training, other, other doctors who control outcomes for careers, for the profession itself, the people at the, in the upper echelons of hospitals, of medical colleges, et cetera, often of regulators, universities, the whole bit. There are pockets of what I call pockets of enlightened leadership.
That, that [00:47:00] kind of came to light on a couple of occasions in my research and the other work I've done in the last six years on this topic. Um, but they're far and few between. They're hard to sustain because they're not happening at the level of the organization. Mostly they're happening at the level of a department or a unit or a hospital.
But where they do occur, they're wonderful. And what I believe is happening, um, in those more enlightened environments is that those senior doctors have recognized, at least to some extent, what I call the medical professional game that is being played. So a feature of the game. Um, and I I drew on the work of a sociologist called Bourdieu for this notion, he devised the [00:48:00] term, the game, but it describes the, the rules that are in place or the game that is played.
Um, in occupations or in any social space in which there's jockeying for power and position, which is pretty much all of them. And a feature of the game is that you don't realize you're playing it or perhaps you willfully misrecognize, and that was his term, misrecognize, that you are immersed in a game and that you are in fact playing it.
And there are reasons why that occurs, but I suspect that those doctors who recognize what is going on, recognize that as detrimental, are those who can actually do something about it and create environments in which people feel psychologically [00:49:00] safe to speak up, which is a term that gets bandied around a fair bit and is a little bit misused, but it refers to the psychological safety to speak up at work, as opposed to, other ways of thinking about that.
And it's not to say that junior doctors or early career doctors is another term, can't get involved in that kind of activity, but they're often not in a position where they can, because of the control that's exercised over their working lives, over their careers, over their job choices, over their training placements, over their exams, by the people who are in fact, the same vehicles for silencing them.
Because there's a lot of, as many would know what I call workplace abuses that occur. In the junior doctor space [00:50:00] that in tandem with the implicit messages they're receiving from university onwards, if not high school, as you mentioned, onwards, about how to behave and be as a doctor. There are a lot of compelling reasons why they don't speak up, because they can't, which effectively eliminates the notion of choice in silence.
I don't know that they're choosing it.
Sharee Johnson: What's the cost? Victoria? I think that, it's all, as you're alluding to, it's a lovely sentiment to think that everybody has autonomy and everybody has a choice and people should speak up. And there's some very interesting research around whistleblowers and what happens to whistleblowers and so on.
I think that's very real across industry, not just in medicine.
Victoria Lister: Yes,
Sharee Johnson: that would have a person that's lower down in the hierarchy that is dependent on references from the people further up the hierarchy to progress their career and so on. You know, there's a lot of good reasons to stay quiet and I think certainly the people that I talk to the doctors that I talk to, [00:51:00] are of the view that, you know, it's a cost benefit analysis. It's, it's less risky to, be quiet. If I, if I'm quiet, nobody can challenge me on it or, you know, I won't end up being accountable or I won't end up being in review or whatever. But if I do speak up, there are all these known potential risks and, and very often people have witnessed a colleague go through those potential risks and so they're very real.
What's, what's the, absolutely, what's the cost for doctors making that choice, which seems the right choice and probably is for some of them, the right choice. But what's the cost of not speaking?
Victoria Lister: Yeah, look, your, your findings are the same as mine. That there is exactly, that. A cost benefit analysis that is conducted by every junior doctor and senior doctors as to whether.
Whether it's going to speak up or not, whether it's worth taking the risk. Mm-hmm. So there's, there's a lot of fear. So there's, there's fear-based violence, which is fear of [00:52:00] the relational risk, the reputational risk, the career risk, the risk to yourself if you speak up because speaking up comes with its own set of challenges.
You then get potentially, if you make a formal complaint, thrust into the world of having to deal with that and who wants to deal with that on top of all the challenges of being a junior doctor, there's risk to others, there's, a sense that collective forms of voice, say union activity are not necessarily embraced either because there's a fear that this is gonna impact the patients.
Because it's often associated with striking, which isn't always the only option available. But I can't do that because I'm gonna affect my patients. There's also a lot of futility. So hopelessness, um, you know, I've seen people speak up. Nothing changes. [00:53:00] Um, there's uncertainty. Uh, I dunno how to speak up. I don't know the mechanisms for speaking up.
I'm not good at speaking up. There's unfortunately, self-sacrifice was another theme. Violence is a strong belief in medicine, that violence is evidence of commitment to calling. So if I can soldier on, um, prove I'm not a troublemaker, I can cop it on the chin, it's, it's can unfortunately, a badge of honor.
Sharee Johnson: I think this is really interesting. You've used the word calling and it's really evident in older literature about how people come to medicine, that it's a calling. I, I'm not sure if our current generations use that word or if they feel it in the same way that maybe they do feel it, but they call it something different.
Were you, you, you know, you were doing some of your work is qualitative research. Were you asking, were people using that language? Were young doctors or [00:54:00] early career doctors using that language?
Victoria Lister: Not that precise language. You're right. It, it is a little bit old school, um, to think in that way. People are more interested in having a career rather than a calling, uh, or seeing medicine as a career, uh, which I, I feel is a, a more balanced mode..
You can, I'm sorry
Sharee Johnson: to interrupt, but you can hear, uh, or it's easy for me to imagine exactly what you said, that if I feel like it's a calling, um, you know, not to say that it requires martyrdom, but there's more kind of sense of I tolerate this, or I put up with this because this is what I was put on the earth to do sort of thing.
Victoria Lister: Yes.
Sharee Johnson: Um, whereas if I'm thinking about my job as my, my job in medicine, which is still has all the elements of wanting to make a difference, wanting to contribute, wanting to care for people, um, uh, wanting to make the world a better place. These things [00:55:00] can all still live without that sense of, , the bigger forces kind of determined that I ought to be a doctor.
Victoria Lister: Mm, yes.
Sharee Johnson: It's a different frame, isn't it?
Victoria Lister: It is, it is. I agree. Uh, nonetheless, there's, there was this sense of self-sacrifice. That still permeates the profession that I, I put myself out on a limb. I put myself last or second. It's about the patient first. And I, I hear this among nurses as well, because I've done a little bit of work with them.
Sharee Johnson: Yeah, I, I completely concur. I meet that all of the time that, you know, I have to show up for my colleagues. That's one of, yes. Other one. Um, yes. You know, what about the patients? If I, if I refuse to work 16 hours, who will see the patient, you know, these, these kinds of things.
Victoria Lister: Exactly. That's, that's what I'm [00:56:00] referring to.
So it's probably, calling is probably not the right term. Um, I'm not sure I even use it in my thesis.
Sharee Johnson: I'm not trying to call you out in that sense. I think, I think, uh, you know, there are lots of, lots of senior doctors have that experience. Yes. Lots, lot for them. Actually, it was Ben Bravery, who I know that, you know, who's a Yes,
recently fellowed psychiatrist in Sydney. It was Ben at, at a conference saying on the stage in a panel that really brought my attention to this saying that I, he was saying I think that junior doctors see their work more as a job or a career. I'm not sure that they see it as a calling in the same way as it might have been described in the past.
Victoria Lister: Mm. Yes. In fact, there's a good paper on this very issue, generational, um, different ways of thinking about
Sharee Johnson: I might ask working conditions. I might ask you to share that with me and I'll put it in the show notes for our audience .
Victoria Lister: Yeah, I could probably share the link.
I'm not sure if it's open access, but if it is, I'll, yeah.
Sharee Johnson: Great. Thank you. So let's keep moving just [00:57:00] in the interest of your time, my time and the listeners' time. 'cause there's still a few things I want to, cover off with you. Do you feel like your, research has garnered interest from the wider medical audience?
Do you feel like people are listening and curious and interested in finding out more about what they can do to create more pockets of enlightened leadership as you call them?
Victoria Lister: Not as much as I'd like. You know, in the circles that, in which I met you there, there are very many interested parties, doctors and, and like us none doctors. There is a, a good reception there. Of course. I, in fairness, I haven't yet published my PhD research, I've published a couple things around it or tangentially. But that is the next step to get it out into some [00:58:00] journals that people are gonna access. I'm always happy to come and speak to people and present on this work and so on. 'Cause I do feel it's so important to talk about, you know, what's really going on here, but no, as yet, and, and I understand why, because my work is kind of critical of the medical profession and what it's allowed in the name of the profession. You know, you, you have this incredible situation where voice is prescribed on the one hand, as in doctors are told to speak up for patient safety.
But, , voice proscribed on the other. So speak up. Don't speak up. 'cause the clear message is you're not to speak up about your own working conditions, put your head down and get on with it. Yeah, and [00:59:00] I, I don't know if many doctors know this, but I, I went and looked for the Hippocratic Oath and, and there's now a modern Hippocratic Oath, uh, which, well probably everyone does know this, but I did not know this.
But the modern version issued by the World M edical Association includes alongside patient safety, practitioner safety, you're not to harm yourself. And that that's a key, uh, tenant. Yeah. So it actually, it actually, Obligation.
Sharee Johnson: Requires obligation.
Victoria Lister: Exactly. Yeah. Yes. And yet the profession behaves in a way that ensures, it ensures this obligation can't be enacted.
Sharee Johnson: Mm-hmm. I really, I, I, I look forward to that time, um, perhaps post publishing, perhaps post podcast this near time that we're coming into where more [01:00:00] people are actively saying, how are we gonna apply this? I, I think the change in occupational health laws around psychosocial risk and psychosocial safety are gonna help us.
And that's, uh, for another conversation. We don't have time to dig into that today, but I, I really want to congratulate you and thank you for the work, because I think it's generating conversation and, and to encourage you that we all feel sometimes, this is so slow moving, but when you've put it into the, the sociological context that you have today about professions more broadly and about how the culture of professions is deep and developed over centuries, really.
Mm-hmm. And, you know, brought into the academics sphere of education as part of its, uh, prestige and rigor that, that these things aren't going to change quickly. And they do require lots of these kinds of conversations where we are saying there is a reality here, which is not the reality we want. Where yes, young doctors [01:01:00] are squashed in their capacity to speak and that that has an impact on patient safety, which is what we all are actually here to try and provide.
Victoria Lister: Mm-hmm.
Sharee Johnson: And that we as seniors, or advisors or administrators or coaches or whatever our other roles are. Can have a role to play in continuing to bring our attention to this issue and to can be a part of the striving to do it differently and more effectively for patient benefit and for worker benefit.
So I really do want to encourage you to keep going. Anybody who's listening to this, if you didn't pick it up, Victoria just offered to come and speak to your group if you are, if you're able to do that. So, um, I guess it's a general kind of rallying call for us to all keep working on this issue of having voice at work and for our medical people to have voice about whatever they see that might affect our capacity to have [01:02:00] great, excellent patient care.
Victoria Lister: Mm-hmm.
Sharee Johnson: How, how do you wanna wrap up our conversation? Is there something we've missed or something you wanna go back to and emphasize as, as a way of moving to our, uh, call?
Victoria Lister: Yeah. Well, one thing is, and I'm sure you, you have said this on many occasion yourself. Um, is that often it's not safe to speak up.
So it, I'm not lively encouraging people to start voicing left, right, and center because there are serious, can be serious repercussions for doing so, but awareness building is, is essential. I mean, let's talk about the fact that we can't speak up and that we are forced to endure often difficult working conditions because of that.
Um, the other thing I just wanted to loop back to was, you mentioned, we were talking earlier [01:03:00] about adaptability and careers and so on. You know, it's been such a privilege for me to meet doctors. I, I love working with them, with you. Um, because you are such wonderful, and I mean you, I know you are not a Doctor Sharee, but the audience Yes.
To the doctors listening. You, you are such amazingly capable, bright people that literally anything can be achieved. And yes, you can have that career adaptability. It's, it's there already. Um, you know, it's a, a wonderful blend of intellectual expertise and hands-on work. So coming back to that notion of merging those two things, you know, the practical with and the craft skills with [01:04:00] something that's a bit more cerebral, I think medicine is a wonderful expression of, of both those things.
And hence the, the capability that I see in the doctors that I meet. So literally, I think if, if there was a focus on awareness of the game that's being played, there can be some work done to dismantle it.
Sharee Johnson: Yeah. Um, as a way of finishing, how do you, what do you keep in mind when you know that you've gotta recalibrate?
What's the kind of mantra or the belief, the little trick that you rely on when there's the crossroads or a moment that you think, oh gosh, need to make a decision here?
Victoria Lister: Usually I try and get myself out of the way. What does that mean? I mean, I, I examine my thoughts, [01:05:00] like, what am I thinking? Is it true or accurate, or am I being fed something that.
Perhaps comes from a societal belief or something someone else has said to me, what is actually true to do in this moment? And in all honesty, I, as my career trajectory will attest. I follow my nose and I guess you could say I follow my body. So what feels like the true thing to do, that's where I land.
I try not to think too much. I, this is a whole other podcast, but I am deeply skeptical of the industry I'm now in. Mm. And see it as problematic as medicine. Mm-hmm.
Sharee Johnson: I love that, Victoria. It sounds like, um, what else might be true or what else could be true, and also that somatic [01:06:00] thing that you, yes, you're right we could have 10 more podcasts together, but that idea of noticing what's in your body as well as what's in your head, that's a lovely place for us to, to land. Thank you for everything you've shared today and really interesting learning more about , your life and the way that you understand medicine.
Thank you. Thank you for the opportunity. It's been amazing.
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