Recording Podcast (Sabine Fonderson) with Sharee Johnson
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Sharee Johnson: [00:01:00] [00:02:00] I'm really excited today because I get to introduce you to Dr. Sabine Fonderson. Sabine and I met during the COVID years online, and, it's, just really exciting to have another long conversation with her. So, Sabine is a general practitioner. She's also a healthcare entrepreneur and a speaker with over 20 years of, international medical experience.
She's worked across four continents, specializing in family medicine and epidemiology, and is the founder of Expat Health Clinic, where she helps bridge the gap between international patients and the Dutch healthcare system through personalized and preventative care. Having lived and worked in the Netherlands, in the UK and Scotland, Cameroon, and in the USA, Dr.
Fonderson brings a unique global perspective on healthcare, diversity, and the realities of practicing medicine in a second language. Alongside her clinical work, she develops AI-powered tools and workflows that help doctors [00:03:00] reduce documentation overload, work more efficiently, and prevent burnout.
Through speaking engagements and educational initiatives, Sabine shares insights on healthcare innovation, digital transformation in medicine, expat health, and sustainable work-life balance for healthcare professionals. Sabine's mission is simple: to make healthcare more accessible, efficient, and human-centered for both patients and clinicians.
Welcome to Recalibrating with Sharee Johnson, Sabine. It's so lovely to see you again.
Dr Sabine Fonderson: It's great to see you, Sharee. Thank you so much for inviting me.
Sharee Johnson: I'm looking forward to this. It's, one of the things that we hear often is, "It's the system," and I think you have such a unique insight onto lots of systems that we'll be able to dig into . But before we get there, you work in primary care as a general practitioner in family medicine in the Netherlands, in The Hague. Yeah. Uh, you also have an interest in AI. You're developing tools for the clinic. You've recently given a TED Talk. You have a podcast. Um, you're on social media, [00:04:00] and I think you're also studying.
So, how on earth do you do all of that? You're a mum as well. Yeah. So, can you tell us a little bit about the typical month in the life of Dr. Sabine at this stage of your career?
Dr Sabine Fonderson: It's interesting. Thank you. Um, a typical month in my life, I wanna just say that, yes, it sounds like a lot, okay? And some people say to me, "Do you ever sleep?" I do. I actually get some good sleep. And I... What I've done in the years leading to where we are today is finding my true core, what I like to do. So, no matter how busy it is, no matter how the system gets me quite frustrated, there are times that I end work and I'm like, "I am quitting my job." But the next morning, I'm like, "I'm going back to my job" Because you have to find- Something that you can go back to that gives you peace of mind, and actually when you look at what you're doing, to [00:05:00] recalibrate, to get that balance again.
And when we met around, uh, COVID, that's what I was really struggling with. I was really struggling with how do I stay being a doctor, be a mom, but also do things that I really like and enjoy? Because exactly what you said in the introduction, doctors seem to think that this is all I have. I, I'm a doctor and that's all I do for life.
I'm here to treat people and care for people and, uh, that's it. And I, I was thinking about something else. I'm like, "But I have other interests. I like other things." I, I'm pretty ambitious, and I tend to say yes to a lot of things, and I used to feel bad about that, but now I'm like, "No, I love saying yes to everything."
And if I say yes to something, it's because I like it. So, um, a typical month would l- will look like being at the practice, coming home, um, you know, making dinner for my daughter, taking time with her, helping her with her homework, helping her prepare for exam, exams that she has. And very important is [00:06:00] working out.
I work out for at least five days a week, and I'm doing, you know, strength training, I'm doing cardio, and that's what helps me balance things out again.
Sharee Johnson: Mm. Has that ebbed and flowed, Sabine, Have there been times where there hasn't been that regular exercise in your life?
Dr Sabine Fonderson: Oh, absolutely. I think I really got down to this particular, um, system or reg- regime that I'm doing right now for a year.
I took a time off a year ago in March, and I had to because I had taken over the practice that I currently own. Mm. And it was one of the most disruptive, chaotic periods in my life because I'd taken over a practice and I got hit with a lot of things in one go. Um, people were leaving, patients were, were going to other doctors 'cause they didn't like the new owner, right?
So there was a new boss in town, and they were like, "Who are you? Uh, I'm used to this other doctor for 30 years, and you're coming over to t- take care of me? Oh, [00:07:00] no." So that made me feel very bad, and, you know, I felt there was something wrong with me. Um, uh, some of the team that I had taken over, they decided to leave.
Um, I was basically stuck with a practice that I had no, um, bond with, and, I had to take care of everything. So I was spending a lot of time focusing on building this practice. So I would, my day would start sometimes at 4:00 in the morning, and it would end at, like, 9:00 in the evening, and I had just enough time to say hello to my daughter and- You know, eat something and go to bed.
So what happened was that, um... And she even came to me one time and said, "Mom, you know, you really need to think about your mental health," because I was so negative about work. So once your teenage daughter tells you that, it's it's a moment in time when you're thinking, "Okay maybe I do need to take a step back and really look around and see what is it that's important to me."
And what's important to me [00:08:00] is my family, is myself, and my work comes, like, somewhere around there. Because I, if I don't take care of my family and myself, I won't be able to take care of my work and my patients. Um, so no, I wasn't always this, uh, consistent. So when I took a, when I finally took a break, I was away for a, a week.
I went to Curacao. I read this book, uh, called Atomic Habits. Uh, you know that one, yeah, by James Clear. And it, something hit. And I said to myself, I used to be the kind of person that if I wanted to do something, I had to be like, uh, if I'm gonna go exercise, it has to be for 30 minutes and I need to, you know, make sure I get these kilometers done and I need to do it in this time.
And what that book taught me was, no, Yeah, your goal is finally to do that one day, but you can start small. So what I would do, no matter how tired I was in the day, when I would come back from work, uh, one, one atomic habit that I changed is that I left work every day at 5:00. I was like, "The work ends at 5:00.
Everybody's out. I'm [00:09:00] also out." So that I was home by 6:00, and I made sure I ate something. And it didn't matter how late it was at night, I would do a workout. Whether it was doing 10 pushups or walking on my tread- treadmill for four minutes, it didn't matter. I just did something. And those tiny changes made it into my life in such a way that now when I'm working out, I'm doing, you know, real good strength workouts.
I'm exercising for 15 minutes consistently, and I'm feeling really good about what I've done, no matter how small. So that's, that's really how, uh, we are where we are now.
Sharee Johnson: Well, that's a beautiful, um, story of recalibration, Sabine. Yes. And, uh, you know, James Clear talks about the smallest dose, doesn't he?
What's the smallest dose that you can start with? You know, one pushup. Yes. But it's establishing the routine. So- Yes ... and so now you're, you're telling us that you're over a year on and you've got this really, uh, embedded routine. It's awesome.
Dr Sabine Fonderson: Yeah, I even post my fails on social media. Like my, my history.
I totally- [00:10:00] Yeah ...
Sharee Johnson: uh, taking vulnerability to a whole new level
Dr Sabine Fonderson: I like doing that because I want to also promote, um, strength training for women who are, like, around my age. Mm. Because as a medical doctor, we have access to quite a lot of information, and I feel part of our job is to disperse that information in a way that makes sense to other people.
And I know that as I am turning ... I'll be 48, I think. Yeah, 48 this year. I want to let other women know that right now is the time to really think about your health maybe in a different way. Um, a lot of it has to do with nutrition, sleep, but strength training absolutely, and more so because we've got all these new drugs in the market for weight loss. We need to make sure that we take care of our muscle health. So this is also the reason why I'm, I'm promoting this, and I'm kind of showing my vulnerability online to, to let women know y- you don't have to be this perfect, you know, athlete and, and have this amazing body. As long as you get some weights and you use it to, um, [00:11:00] to strengthen your core, it's, uh, it's gonna help you in the long term.
Sharee Johnson: Hmm. It's the, it's the consistency I think that you're pointing to. Yes. I went back to the gym in July last year too, and the consistency- Nice ... is that regular habit. It's really, uh ... You know, I think we do well with routines. We don't wanna be so rigid, that we can't adapt to life. But having some routine is a great support- Yes for our wellbeing. Yeah. Yes. Yeah, absolutely.
Let's go back, Sabine, to kind of maybe not the very beginning, but let's go back to your early years. Where, what, what was happening then? Did you come from a medical family? How did you find yourself in medicine, from your childhood, from your family of origin?
Dr Sabine Fonderson: I don't come from a medical family at all. My earliest memories of how I even started thinking about medicine was, you know, the, there comes a time when you have that conversation with your parents, right? You ... And I'm having this, uh, this now with my daughter.
She's 14, so we're already thinking about, okay, what does she like? What, what would she like to do? We haven't yet gotten there. When I was around her age and when, you know, I was having a conversation with my mom and, uh, she's like, "Okay, what do you wanna do?" [00:12:00] And I literally looked at her and I said, "Oh, I wanna be, uh, like Whoopi Goldberg."
And, uh, 'cause i- I was always known as the class clown. I was always making people happy and joking around, and I don't think my mom liked that at all. Uh, so she's looked, she looked at me, she's like, "Uh, excuse me?" I said ... She's like, "No, I, I mean, like, what are you gonna do as a career? Like, you know, how are you gonna make money and live?"
And I was like, "Yeah, but Whoopi Goldberg makes money," right? Yeah. Yeah. And, it didn't, you know, like, link with my mom. So she left it at that. She's like, "We'll have this conversation later." So, a, a, a while later we, we sat down again and she ... At that time, I don't think she even asked me what I wanna do. She just basically gave me a few options. She's like, "You're gonna be, uh, either a lawyer, a dentist," you know, I think she said an astronaut, I think. Maybe I, I added that in. Or a doctor. And we went back and forth and I was just like, "Well, I don't wanna be any of these." And, um, again, nothing against, uh, you know, how [00:13:00] parents raise their children.
But I think for me, the fundamental thing that I learned with that is that, um, because we kept on going back and forth, I actually remember asking her, "Okay, if I become a doctor, can I work anywhere in the world?" Because at that age, I really wanted to travel For me, discovering the world was something that was also very important.
And she said, "Yes, of course." And that clicked for me. So I decided, I compromised with my mom. I'm like, "Okay, I'm gonna be a doctor, but then at least I get to travel." And that's how I ended up, uh, studying to becoming a doctor.
Sharee Johnson: Mm. And now, are you happy with the decision?
Dr Sabine Fonderson: Um, yes and no. Um, and I'm very honest about that. I think the, we need to also be aware how, you know, we're talking about 20 years ago when I actually, graduated, and it takes, it took another six years, uh, for me to graduate. So 26 and then four. So we're looking at probably 30 years ago from the moment that I made that decision to now, so much has changed.
It's, [00:14:00] it's insane. So much has changed. Um, yes, um, because having done medicine, you learn a lot about yourself. You learn a lot about people. Um, it's probably one of the only profession where your emotion are fluctuating up and down, up and down, and you have to always be steady, you know? Focused. So you're challenged a lot.
So it's one of those professions where you need to, you know, have a, a, a good ground in your core to be able to undertake all these different facets, the personalities, the diseases, the, the insecurities, um, the, the questions. And I went from medical school, graduated, went straight into A&E, emergency medicine, and then later on I did family medicine.
So I've seen quite a lot of things. Mm-hmm. So yes, I, my decision to become a doctor, I'm very happy with it because it has given me so many experiences. I've [00:15:00] seen so many things. I've helped a lot of people. Uh, no in the sense that the system has not, unfortunately, changed in a way to allow, let's say, people who want to get into this profession to discover their other skills, their other abilities, what they can do next to being a doctor.
I feel once you have the title doctor, everybody just dumps that and says, "Okay, you're the doctor. You know everything. That's it. You cannot do anything else." And me, I'm like, "But I like to discover things." Mm-hmm. And, um, it, it doesn't allow you there to do that. So those are the challenges I face. Um, but now in my later years, and now that I have my own practice, I'm thinking, "Well, now is my time to actually develop those skills and, and, uh, make my own path."
And I'm very excited about this future, especially now with the tools that we have.
Sharee Johnson: Does having your own practice give you a bit more autonomy, give you a bit more flexibility in, in those decisions?
Dr Sabine Fonderson: Absolutely. Definitely, [00:16:00] um, 100%, I would say, because having your own practice, well, it's your practice.
Mm-hmm. Uh, obviously you have, there are guidelines that you have to follow, but within those guidelines, um, I am able to do so many things with my team and, um, which I wouldn't be able to do if I was working, for example, in the clinical setting in a hospital, which I've worked in before for many years.
Like I said, I, I used to work in A&E for, for many years. And yes, it's fun to work in that setting, but you have l- less autonomy. And that was what happened when we met around, uh, COVID time. I'd come from a, a very demanding workload as an, uh, emergency medicine doctor. There was COVID, I had burned out, and I was trying to find my path again, and I knew I couldn't, I could no longer go back to what I had gone through, so I needed to find something else.
I went through a coaching, um, session, a few coaching sessions actually, and I was so happy that I found this lady who helped me understand that part of who I am is that discovering. I love discovering [00:17:00] things. I'm an entrepreneur. And we looked at all the different fields of medicine, and family medicine actually fit me at that moment because I could own my practice, and because I had such a diverse, um, experience, it, it really helped me define, okay, for the, for the next, you know, phase of my life this is what I want to bring, uh, forward and, and continue. Yeah.
Sharee Johnson: Mm. So just before we go into all of that, because I know that's where the exciting parts are- Yeah Can we just, um, explore a bit more of the recalibrating that you've done? When you were first working in A&E, was that in the NHS in the UK, or where were you?
Dr Sabine Fonderson: Yes, absolutely. Yeah.
Sharee Johnson: So can you share a little bit with us about these changes across the different countries and what your experience was as a doctor as you were adapting, I suppose, to each of these different systems that you were working in? Mm. What did you learn, either about medicine at that global kind of level, or even about yourself as you were adapting from one place to the next?
Dr Sabine Fonderson: I'm gonna go kind of back and forth simply because it was a while ago, and a lot [00:18:00] of things I'm going through now, um, is because I see young doctors who are coming to the Netherlands, and they speak a second language, right? Mm. So they, so Dutch is not their primary language. But let me just start, when I graduated, I actually graduated in the Netherlands, so I, I, I learned the Dutch system.
But I was raised in the Netherlands as an expat because we came with my parents, uh, when I was young, and before that time, I was raised in England, but I was born in Cameroon. Mm. So, you know, so there's a whole journey there. You've been a global citizen your whole life. Right. Um, and so, um, even though I, I, um, graduated, um, here in the Netherlands- I- in the Dutch system, I wasn't really integrated in the, in the Dutch culture, most of my friends, and my identity was a lot more within the expat community.
Meaning that by the time I graduated and I got into the work life in the Netherlands, I really struggled to, to fit in, and I didn't get into the clinical setting immediately. I actually [00:19:00] did research for a year and a half, and I thought, "This is, this is not for me. Um, I wanna go back to England," 'cause I had, you know, I, I really missed England.
So I, I literally got on a plane and I moved to, to London, and I felt, welcome here. I'm like, "This is, this is where I, I belong," 'cause it was in English. I think in English. My community is, you know, English-speaking. So settling in the UK was, for me, the best decision. I got into the NHS, and then I was hit with, wow, this is really clinical life.
It was intense. It was chaotic. It was, it was insane. I, I thought to myself, there's actually no ... Well, I, I was just basically, yeah, "Oh, you're a doctor. Come and work in this, uh, department, and you're on your own." And it was very different than in the Netherlands. In the Netherlands it's like, okay, you're new here, but you're gonna have somebody to, to, you know, that you have to report to.
There's a very, you know, hierarchical system in the Netherlands [00:20:00] also you, you can't make decisions. Even though you graduated, you're not the final decision-maker. And what I found in the NHS was because it's so big and there's just such a huge need in doctors, you could just get in there, and all of a sudden you had a whole department and you were in charge.
I, I, I, I was overwhelmed, 'cause I was like, "I've never done this before." So those are the challenges I faced. Anyway, I, I got through that. I, went further, got some extra, , courses, read a lot of books obviously, 'cause I really wanted to make it work, and then I, I got into A&E and I thought, yeah, this is really what I like.
Um, and what happened was that as I was, you know, going through my, my experience, one of the things that helped me recalibrate was, again, finding what I liked within that very intense workload. No matter how difficult it was, I always had to ... One of the things I said, "But can I sustain this for another year?
Can I sustain ... Do I see myself doing this for another year, another two years?" And [00:21:00] if the answer was yes, I just continued, because for me there was no reason at that time to, to jump ship and go somewhere else. And like you mentioned, doctors typically, when you choose a path, that's where you, you know, you stay.
And, and England was very different than the Netherlands, like I said, was because England, like, it's, it's just so big, and everybody comes in A&E, and I, I was, subjected to so many different- you know, conditions and I was allowed to do things, and I was like, "Wow, I can actually make decisions."
So I felt really confident about myself. So by the time I came back to the Netherlands and I wanted to go back into the A&E setting, you know, here it's like, no, you can't make those decisions because, um, A&E in the Netherlands at the time was not a specialization on its own. So even if you work in, in the A&E department, so somebody coming in with chest pain, you as a medical doctor had to first call the cardiologist, and the cardiologist would say, "Oh no, don't talk [00:22:00] to me you have to talk to my junior cardiologist." And, and then one day, I've, I'll never forget when I was in Netherlands working in, in A&E, I had done a lot of experience in England, NHS. So I'm, I'm here trying to find my bearings again, and I call somebody, an orthopedic surgeon, and he literally said, "No, call my junior." And then I called the junior and the junior said, "No, you have to call the intern." And I lost it. Mm. I'm like, "I'm sorry, I don't even wanna call any of you 'cause I know what I need to do," right? "And you want me now to call the intern and discuss with the intern what to do with this patient?" And that was me. That was when I said, "I can't do this." You know, you're coming from a position where you made decisions, and now you're in the Netherlands and the, the, the rules are so strict, you, you, you have no autonomy, uh, in certain things. So that's when I realized, um, the clinical setting in the hospital is no longer for me.
And like I said earlier, I went through this whole coaching session to find out what really did work for me.
Sharee Johnson: Mm. [00:23:00] When you're thinking back, Sabine on these sections, I suppose, in, in the UK in London and the, where the hospital work in, in the Netherlands and now in your own clinic in, in primary care, what helped you?
What were the resources or the insights that you had, that helped you make each of those shifts? So one of them is you talked about the coach having a sounding board, but what else helped?
Dr Sabine Fonderson: I think the main thing that helped me make this shift to, to where I am now is my daughter. Like, she was growing up, and I remembered every time, Sharee, there was not a year when I was doing A&E that I ha- that I didn't ever have to work in, during holiday seasons, right? Christmas, New Year, Easter, every holiday season I had a shift. And then you had to combine it with night shifts, and then you had to combine it with missing out on a lot of social gatherings. I had missed my friends' weddings. I had ... There was one time that, unfortunately, one of my very dear friends, uh, had passed away, and I re- of course, I [00:24:00] really wanted to be at her funeral to say goodbye, and the, the struggle it took for me to take that, those time off just to be able to attend her funeral.
And I said to myself, "This is not okay. Um, uh, this is not how I want to continue." And not seeing my daughter or, you know, growing up because I had night shifts and I had to find a babysitter, or I had to make sure that she was somewhere else whilst I was working. It was just too much disruption for me. And there came a point in my life where I needed to, um, to, to focus on her and being there with her. Even though she's going to school now, she's in, in secondary school, I want to be able to work on the times when she's at school, so when she's finished from school, I'm home. And that was, for me, important. And when there's weekends, we are together on the weekends, and I needed to decide more for myself, am I going to do those weekend shifts, yes or no? And the answer was no, um, because now I have other priorities.
Sharee Johnson: Mm-hmm. I love the integration that you're [00:25:00] pointing us to, Sabine, that, you're not somehow two separate selves. That, when you're at work, you still have a daughter and a and an outside life. And when you're at home- Yes ... you still have a, a medical working life. You know, these things are integrated. Yes. They're not, you know, they're not completely compartmentalized in a way that, I think, doctors, and probably women doctors, have been asked to do in the past, that we're, you know, we're really pushing back on that now because, um- Yeah well, it doesn't actually make any sense in the modern world.
Dr Sabine Fonderson: No, it, it doesn't. Um, with all due respect, we want women who are perfect everything. Uh, you have to have a ... If you have a career, great. But some others say, "Oh, but why'd you have a career?" If you have kids and a career, "Oh, how, how can you do that?"
Um, but you should have a, uh, kids and a career. It's this, this, this very, you know, balance, finding this balance where you're thinking to yourself, "But what about me? What do I want?" And this is where I come back to the system. The system does not, unfortunately, [00:26:00] allow people in, uh, many healthcare professions to explore those desires, those skills, those ambitions, and I think it's a wasted opportunity.
Um, because you might be at the stage now, or for me, where I'm thinking, "Well, I have my practice. Within my practice, I wanna be more innovative." And I'll give you an example. Um, a- about four months ago, December of last year, so 2025, I reached a point where I was like, "I understand these signals." My body was giving me signals, and I'm like, "Okay, I recognize these signals as burnout." And I wasn't sleeping very well. I was extremely frustrated about a lot of things. And I took two weeks off, and I, I just told my manager, "I have to take these weeks off. I, I can't do this anymore." So I went one week by myself away, and then the second week, it was around Christmas, where I took my daughter and went, uh, to, to, to Portugal.
And I remember coming back and I [00:27:00] said, "Okay, Sabine, something has to change." And what had to change was that I was, you know, from Monday to Friday, I was just seeing patients. Only seeing patients. My agenda was completely full with patient care. Not a problem, because I'm a doctor. But what I was struggling with, and this is where, again, my TED Talk comes in, I was losing the, the joy because I was miserable just only seeing patients.
I wasn't exploring all the other things that I liked within my practice. I was missing out on actually taking care of my practice, because my practice is a business. I needed to take care of the finances. I had totally lost sight of my financial situation. I had totally lost sight of my personnel. I totally lost sight on the processes that make the practice work.
All I was doing was taking care of patients with knee pain, ear pain, uh, a little bit of, like fever. And I'm thinking, "Wait a minute. Yes, they wanna see me, but are they coming to see me because they really have something that I, only me, can take care [00:28:00] of? Or can they see another colleague?"
And I'd made a shift, and I remember telling my manager, "We have to change this because I, I cannot continue like this. I, I recognize the signs, and if this goes w- if this moves forward, I'm, I'm closing the doors and I'm doing something else, because this is not okay." And she's like, "Okay, what do you need?" I said, "I need you to block my agenda so that I can recalibrate, right?
I can get back to myself, and I can, I can go back and understand my finances and my practice." 'Cause it, you know, there's so many things going on that I just get letters from my accountant left and right and this, and, and I didn't understand anything. I have to understand the processes. We have to take care of chronic care.
We have to take care of patients who are, you know, palliative, and, uh, nobody was doing that properly. Mm. So we wrote a letter to all my patients, the 3,000 plus, and we said to them, "Dr. Fonderson is now going to take a step back," and there will always be enough clinic availabilities to be seen, because we have a team.
And I'll never forget [00:29:00] how the first two weeks that we did that, people literally were thinking that I had quit. Mm. They thought that I was no longer a doctor. I was getting, you know, mails and telephones like, "Oh, Sabine. Oh, I didn't know you were still around. That, that letter, I, I thought you left.
I thought, you know, you couldn't take it anymore." I said, "But we- no, I..." All I said was that I'm taking a step back to take care of my practice. So it's very interesting how people, um, uh, understand my own desires, because at that stage, I needed to find time for myself again. And what I wanna say with this story is that your body tells you enough.
You need to listen to it and take action. Don't be scared. It was, what I did was risky, um, but I have no regrets because I go back to work now feeling fabulous.
Sharee Johnson: I call that self-leadership. I think that, you know, you l- you showed some leadership for yourself, and actually the other people experienced that leadership too because they saw that you, um, were able to pause and [00:30:00] create something else. And that's important modeling for the other doctors- Yeah ... the reception team, a- and ultimately for the patients, that they're-
Dr Sabine Fonderson: I hope so. Yeah ...
Sharee Johnson: another way of reminding that they're, that you're human.
Dr Sabine Fonderson: And this is exactly what I say to them. When they came to the clinic, like, they would see me at the clinic. I'm always at the clinic. There's probably one day a week that I might not be there because I also want to take some time away from the clinic. But once they see me, they're like, "Oh, but you're here." I said, "Of course I'm here." And I said, "For the last two years, I've dedicated my, my time taking care of you. Now I need to take care of my practice." And I think, you know, wording it like that, they, they do understand.
Sharee Johnson: And you've mentioned your TED Talk, so let's go there. Um- Mm ... and I, I do wanna come back and ask you about Cameroon and the USA at some stage too. Mm. But the TED Talk I think was really interesting. You were talking about the art of medicine, essentially, and we'll put the link- Yes ... in the show notes so, uh, the listeners can find it easily. You were talking about the c- the art of medicine and, and that being a medical practitioner is a craft, and that it [00:31:00] takes time to develop, and that it involves the art of medicine as much as anything else. Can you tell us a little bit about the messages that you hope to, to impart through your TED Talk?
Dr Sabine Fonderson: Yes. If I look at my early days as, you know, starting off as a doctor, once you get that diploma and then the moment there's that signature, you get your number. Every, every doctor always gets that number.
In the Netherlands it's the BIG. In England it's the GMC. I have no idea what it is in other- in Australia, I don't know what that is. Um, but you get, that number, and yes, now you can make decisions and you're a doctor, right? What I remember the early days was for me it was all about patients coming in and making sure once I saw them, once they came with their conditions, I should be able to have a diagnosis and a plan.
That was, that was all you're taught, right? You like, once somebody comes in and says, "This, this, this," you ask these questions. In your mind, you're already processing the [00:32:00] information. You're kind of looking, remembering the textbooks that you saw them in, and you have an idea that this is it.
It took years for me to realize that many times, 'cause I had these conversations with patients and I, and I, and I couldn't understand why- I thought I'm really good at diagnosing, right? I'm good at coming up with a plan. But patients would be like, "Ugh, I went to see that doctor and, you know, she, she didn't take, she didn't pay attention to me," or, um, "She completely missed, you know, the, the whole reason why I came."
And I would really struggle with, okay, did I not communicate properly? What, what did I miss? And the craft of medicine is literally getting people, and this is what I realized later on, when I realized that my job is not necessarily to give a diagnosis, obviously that will come, but my job is to make people feel heard.
When I realized that that's what it is, this is what [00:33:00] they need I realized that, oh, then I, I can take my time, especially in, in primary care. This is what I tell a lot of my, uh, colleagues, especially the young ones, 'cause I see them struggle, right? 'Cause in their mind they're like, "Oh, but I need to have a diagnosis, I need to have a plan," and then they need to get better.
And now I tell them, "Listen, this is not A&E. This is not emergency medicine. There's no, there's, there's hardly ever any blood that we'll see, right? There's, there's hardly any broken bones that we're gonna see. So take your time. Your job at that point in time for those 15 minutes that you have is to make sure that you have made that patient feel heard.
If you've accomplished that, you've done 90% of the work. You've done 90% of the diagnosis, and the plan is literally secondary." Um, so that for me is one of the most important thing, um, I've learned, and that's a craft. It takes a long time. And you see that also with more mature doctors. You can see them also in the clinical setting where they're more relaxed, they're just [00:34:00] more laid back and then they say, "Okay, talk." And then sometimes what you hear, and this is what I also saw with more mature, primary care physicians, is you would see the patients leaving , the clinic room laughing and smiling, , and they're just like best friends.
And I'm thinking, how do they do that, you know? And it's a craft. First of all, yes, you need to sometimes take time to know the patient. But particularly if they feel heard, they might come with you with knee pain, and then at the end of the day, if you only solve that knee pain and you forget the fact that actually she's also struggling with weight problems, she's not sleeping well, um, you know, she has financial problems, she can't get that knee operation, and you're supposed to get all of that in 15 minutes, it's a craft.
Sharee Johnson: It sounds like, I mean, you smiled so much at the beginning of this part of our conversation, it sounds- Yeah ... it's more fulfilling or it's more rewarding when you're able to practice in this way, when you're listening more attentively, when your goal is to help the patient feel heard.
Dr Sabine Fonderson: [00:35:00] Absolutely, especially in this setting. I'm not saying in a setting where somebody comes in, , with a broken, arm, and you're like, "Oh, so how was your weekend?" Nobody, you know, you, you have to ... It's in the context, right? But when you have, um, when it's not acute, when it's not life-threatening, I think that we need to make sure that we develop more that art of really listening to what the patient is saying before we jump to those diagnoses.
And what I tell a lot of my, my, my colleagues, the junior doctors that are starting out and they're, and they want to understand what primary care is about, I always tell them, "Just, just take it easy, you know? Take your time. You have the time now to grow and learn." And many times I say, "As long as you know that the patient has felt heard, you can tell them to go home," and you can say to them, "You know, I'll call you back at the end of the, at the end of the afternoon.
Um, I'm gonna just discuss this with another colleague just to make sure that we get this right." I never want them to feel pressured to get the diagnosis, A, right in the, [00:36:00] at the first, uh, go, or even have a fantastic plan, because that plan can go completely out of the window once the patient leaves and says, "Yeah, that doctor didn't listen to a thing I said," right?
Mm-hmm. Mm-hmm. And this is something, it's what happens. Um, you can have a patient, then you're like, "Oh, I, I got this." I even talked about it in my TED Talk, uh, this lady with the mascara. You know, I was like, "Oh, that's the, that's the reason why your, your eye is red and bladebla," but technically it was the reason, but she, she felt completely unheard. And for a whole year she avoided coming to me, and I've, I thought this is a missed opportunity. So I really wanted to, to, to highlight that story and make sure people understand make sure your only goal at that time is to, did that patient felt heard? And it's okay to ask, "Did I cover everything? Have we gone through all the things that you wanted to talk about?" Yeah.
Sharee Johnson: Yeah, that pressure creates all sorts of problems, doesn't it? The research says that doctors, depending which year you look, that doctors interrupt within up to as quickly as 11 [00:37:00] seconds, uh, when the patient comes into the room because of that pressure, that idea that I've only got 10 minutes, I've only got 15 minutes, I've got to find everything out.
And exactly as you said, the patient is much more likely to tell you all the stuff, uh, if you give them a little bit of room, one, two minutes to talk, uh, and tell you at the, at the outset to feel heard.
Dr Sabine Fonderson: Exactly, and one of my AI tools does that 'cause it transcribes. And, and I, I remember putting that AI tool into another AI tool and looking at how many percentage of the time am I talking, and what is the percentage of the time that my patient is talking?
And I was so happy when I realized that 80% of the time my patient is talking. I was like, "Yes, this is great." Awesome. You know? Awesome, well done. Yeah. Yeah, and I, yeah, and this is what we need to understand is that, yes, there's a pressure to do things quickly, and most times I'm always running behind because I wanna give space to my patients.
And I sometimes say, "Okay, you know what? It seems like you really wanna discuss things. I do have other patients. You can come back [00:38:00] tomorrow. We can make a new appointment." But I feel like this time is the time for us to discuss all of that, and I'll come back to certain things later on. I can send you an email. I can call you. I want doctors to realize that there are so many more tools out there now to get your message across. You don't need to, at that moment, tell them a whole bunch of things about how dangerous it is, you know, to take that medication. Yes, obviously you can highlight, you know, side effects, but you can do that later on and say, "Look, uh, you know, I'm running behind. We're gonna start this treatment. Uh, I'm gonna send you some information at home to take the, your time to read, and then if you have any questions, get back to me." We need to be more versatile and flexible when it comes to our patient's interaction.
Sharee Johnson: Before we get into the AI stuff, can you tell us a little bit about , what happened in Cameroon and in the USA? What, what work have you done in those places?
Dr Sabine Fonderson: In Cameroon, when I graduated, in my last two years of medical school, I actually took another course and I did small business, small business management. I think from young [00:39:00] I, I knew that I was an entrepreneur, like, I wanted to do something with, with business. 'Cause my dad, you know, he's an entrepreneur. He would, he always had his side hustles even though he worked in, big organizations. And I remember I told you I really wanted to travel. My dad used to travel all the time. That's what we did as expats. So that was already part in me. When I was in my last two years of medical school, I saw a, program and I'm like, "Oh, this, this is great. I'm gonna learn about, you know, starting a small business." When I finished that, um, that course, I had an idea, and w- by that time I was going to Cameroon with my family on holidays. So imagine I was born in Cameroon. I don't have any memories of being raised there 'cause I left when I was about three or four and we went to England.
I don't have much m- memories of, Cameroon itself, but we used to go back On holidays, right? And then when I was about 19, I was like, "Oh, I really wanna find my roots. I wanna discover where I'm from." So I went back to Cameroon [00:40:00] and I was supposed to stay there for, I think, eight weeks, and I combined it with, like, an internship where I went into the middle of nowhere.
I, I found this amazing, um ... Well, it was actually through a colleague of mine I was working with, and she said, "Oh, we have a project in this hospital in Bangang Tekoun." I was like, "Where is that? How is it that Dutch girl, you know, Dutch doctors know more about Cameroon than I do?" So I traveled. I asked them, "Can I come with you guys, uh, the next time?"
So they said yes, and I incorporated that with one of my final, school, interns. You know, when you, when you do medicine you have to do, like, an extended internship. Yeah. So, I combined it with that and, oh, it was, it was amazing. I had the time of my life. I, got sick so many times. I developed typhoid fever, but I was like, "I am happy here," you know? And, um, it, it, it gave me something back where I said, "I don't know Cameroon, but I wanna know it, but I wanna do something, give something back. So I started projects myself. And having finished [00:41:00] that course on small business management, I started a, a company called Students Help in Africa.
Because at that time I was a student, and I ... It made me go back to Cameroon I think about four times a year. And I started a project where I would help, uh, other students from other countries go to Cameroon and do their internships. So that's what it did. And I was developing my own websites. I was, you know, doing my own promotion.
I mean, this thing took all my time, and I loved every single second of it. So my first ever student was a young student called Mary from the United States. She left the United States to fly all the way to Cameroon. I'm like, "Okay, you, you really, you know, you're doing something that even I myself haven't done."
And I got everything arranged for her. She had an internship in a city called Bamenda. I had, you know, I ... 'Cause what I did, I, I built con- con- contacts in different places in Cameroon, and I talked to [00:42:00] doctors, and the doctors were like, "Great, we can host these students." So they would pay us a fee. I would give that fee to, uh, to the host families, and then they would spend a few weeks in the hospitals, and they would live there as, you know, uh, as part of the community.
And she was my first student. And then after that it just, it just blew. And, um, the, you know, the following year I had two students from the Netherlands. They came back. They talked about it. A year later I had, like, 40 students. Long story short, I sent over 250 students to Cameroon, right?
Sharee Johnson: Wow.
Dr Sabine Fonderson: And it was a huge project, and I would h- I would host workshops, and I would teach them how to, you know, do venipunctures. I would teach them how to do sutures so that while, whilst they're there they can also feel, you know, handy. We had projects where we would be sending, um, computers. We were sending, you know, um, school equipment. It was really, like, one of the best things that I've ever done.
Sharee Johnson: A passion project.
Dr Sabine Fonderson: And it was one of the best passion projects. And my [00:43:00] aunt, uh, she took a lot of the, you know, the burden also over because she was like, "Oh, I can help you with this." So I was doing this with my aunt, and we grew and grew and grew until, um, when I gave birth to my daughter, , in 2012. I had delivered my daughter, and a few hours later I got the news that my aunt passed away.
Oh. So i- th- that completely disrupted my life. I, I, I was like, "What? How does, how can that happen?" And, because my aunt wasn't there anymore, yeah, the project just didn't have the same meaning, um, that it did. And with a lot of pain, uh, three years later I had to, I had to stop it. Yeah.
Sharee Johnson: It ha- must have had impact in so many different directions. It must have had impact for those communities where the, the students were- Yeah ... coming to work. It must have had impact on those actual students themselves individually. Um, they've gone back to wherever they came from and, and talked about Cameroon and their experience- Yeah ... in Africa. Yeah. Yeah. There's ripples [00:44:00] upon ripples, Sabine.
It must be very satisfying. It, it, you know, even though there's a sadness in you for it to have had to close up, it must be a very- Mm ... satisfying part of your history to reflect on this.
Dr Sabine Fonderson: It was by far one of the, again, it was my, my, my first project right after finishing that, um, that course. And I was like, "This is it. This is all I wanna do." And, um, um, but obviously I couldn't make money out of it.
Sharee Johnson: A love project ...
Dr Sabine Fonderson: I wasn't able to pay m yeah. It was a love project. I couldn't pay my bills from it. And I remember my mom telling me, "It's a project, Sabine." I was like, "Yeah, but I really like this project," you know? But yeah, it, it's, to me it's one of the most satisfying things I've done. Yeah. Absolutely. Oh, yeah.
Sharee Johnson: What a gift. Just think that the lessons that people were learning in that time- Yeah ... have, have stayed with them their whole life, I imagine.
Dr Sabine Fonderson: Yeah. Yeah, yeah. And we tried to replicate the same concept, a few years ago. I started it again. I was like, "Oh, I really want a passion project again." And then I called it, um, I named it Tiba, and I had contacts in Kenya and [00:45:00] we-- I sent about six students, I think, in total. Um, but it, it, it wasn't there, you know?
It, it's just not the same. And I, I can't go through with something if I myself am not 100% behind it, you know? Yeah. Although the host family in, in Kenya, they were amazing, um, I have never been there. Mm. So I'm relying on third party- Yeah ... to tell me how it is. But Cameroon, I had been to every single place.
So when I, when I sent a student there, I would tell them from my own view- Mm ... so that I made them realize that, "No, this is what you're gonna see." I took photos. I was literally, you know, a, a, um, travel agency for, you know, promoting Cameroon in one of the best ways. And I even used to travel with some students so that I could be part of that and I would make sure that they settled, and then I would leave and go and visit other family members.
Sharee Johnson: I don't know anything about medicine in Africa or certainly not in- Yeah ... in Cameroon. Is there something you can share with us about that in terms of, you know, thinking about systems [00:46:00] and healthcare systems?
One of the things that I notice is it doesn't matter what system you're in, there are systems problems. So even though- Yes ... systems are different, uh, for individual clinicians and for patients there are problems. It's, it's part of, in some ways it's part of just big systems. Unwieldy- Yeah ... big systems. You know, you were talking about the NHS earlier on.
What's something that we can learn or reflect on or that we might be, um, curious about i- in Cameroon's health system?
Dr Sabine Fonderson: Well, you have two main systems. You have, uh, the public health and private healthcare. Public healthcare unfortunately in most regions of Cameroon is, it's terrible. Um, what I've seen is there's no words to describe. I think it's, it's, uh, people should go themselves and, and experience that because when you, you go to a hospital in a rural setting, parents bring a child, and that child literally has minutes to live because they've waited so long, 'cause they don't have the money or they've traveled so [00:47:00] long, and you see young kids die in front of you because the facilities are not there, parents don't have the money. I mean, it, it's mind-boggling. It, it doesn't make sense, especially coming from a system here- Mm ... where with all due respect, parents bring their child with a small runny nose, and they're already like, "Oh, no, my kid can't breathe." And so I have difficulty sometimes, and I even, there are times when I tell patients and I say, "Look, you are living in a system in the Netherlands," and I say to them, "I would like you to understand something.
I've worked in many different settings, and you can complain all you want about how we give care in the Netherlands, but let me say that the Netherlands is by far one of the best healthcare systems there is because you have accessibility, right? You have a phone call. I'm a phone call away. You know, I'm 10 minutes away.
There is, at any time in, in, in, you know, in your life, whatever help you need, if you have a little cough or [00:48:00] a headache, you have accessibility. You can find somebody to help you. You travel eight hours to another continent, and that accessibility is gone. It means that you, you don't have life anymore because you can't get that help."
And I try and put that into perspective, not to scare them, but just to make them understand perspective. And I, and one of the things I say is that, "No matter how sick you are, sometimes when you're sick, you might be sick for two days. I, in two days I don't know what you have. Sometimes you have to let your body figure it out, right?
You just have to just be sick for a couple of days and we'll figure it out. I, I don't need to diagnose you now because I'm actually just, um, um, treating a symptom. I wanna treat a condition." Mm. And in a setting like Cameroon- You see people survive things for so long, and then you realize, oh, wait a minute, you know?
Your body is able to take care of a lot. So the contrast is so huge to me sometimes. When you look at Cameroon and you, again, you have private care, [00:49:00] you have, uh, public care, and even in private care you might have better facilities, but it doesn't mean that they're gonna save your lives. Mm.
You know, I've had ... I know people who've gone to a private clinic, and they still unfortunately passed away because at that time there was just no, you know, there was just no medication still. Or even though they had the money, uh, maybe the, the, the machine wasn't working, so they couldn't get the scan they needed. Mm. It's, it's crazy. It's absolutely crazy.
Sharee Johnson: Yeah. I think it's easy for us in the, in the Western countries to lose our perspective in that way. Exactly.
Dr Sabine Fonderson: Absolutely. Yeah. Yeah. And these are things that maybe I might, ethically I might not be allowed to, to think like this, but I try to bring it in certain conversations just to have people put things into context.
Just as I believe that they want to have the feeling that they're heard, I think that they should also understand that from the medical perspective, we're not here to, to resolve every single little issue. That's just impossible. Yeah. So I, I use that a [00:50:00] lot. Yeah.
Sharee Johnson: Mm. And having said that, though, you have, uh, worked hard I think to help the expats who live in the Netherlands have access- Yeah- and understand. So maybe it's a good time to hear about that, that, you know, this reality. I had a nephew that lived in, the Netherlands for 12 months actually not so long ago. I was thinking about him as we were coming together, these young people from Australia used to, and New Zealand I think, , London was the place they went for a long, long time. That's where I went when I was a young person, and that was our base. But with the changes in the world, a lot of people are coming to the Netherlands now as the sort of central European place to kick off from. Yeah. Tell us about your expat work.
Dr Sabine Fonderson: One of the reasons why I, started the Expat Health Clinic was because- When I was in England, around the time that Facebook was happening, WhatsApp was around.
I used to get people, 'cause they know me, a- and then they'd be like, "Oh, hey doc, uh, can you help me with this?" Um, and because, [00:51:00] yeah, everybody is like, "You're a doctor, so you know everything," right? So my, my Facebook messages and my WhatsApp messages would just explode because people will be traveling, and then they're like, "Oh, but I know Sabine. She's a doctor, so she can help me," right? And I would tell them, "Yeah, I know you, but I, I can't help you. I mean, that's not how this works." And I'm very, very strict about, you know, friends and family asking me for medical advice because I'm like, "That doesn't match very well." But, um, my number used to get spread around, and I would get people, you know, just asking me questions.
And I thought, "Oh, let me put a platform out there. Let me just, you know, answer these questions," because a lot of people are facing these cultural differences, right? Mm-hmm. Just like I mentioned, when you leave from, uh, from the Netherlands and you go to Cameroon, you're gonna be ... You know, you're gonna have a culture shock 'cause things are so different.
It's the same thing as you might be leaving from Cameroon or from the United States or from where, Australia, and coming to the Netherlands. It's still a culture shock 'cause the healthcare system is different. Anything that's different is gonna be a shock to your system. [00:52:00] So and what I found fascinating is people coming in with their context, right?
With their perspective. So a lot of the, my patients that I get, my expats, they're coming from countries like America, and they will come to me and say, "Yeah, well, you know, um, I have a headache and I wanna go to a, a neurologist." And I say, "Well, in the Netherlands we have this thing called primary care, where first a GP like me will assess whether or not I think you need to go to a neurologist, because we are the filter.
Otherwise, hospitals would be completely full, and there are not enough doctors , to work in these hospitals, and that's not how it works." And I try to, uh, let them understand that whole process, because one of the things is that they get frustrated. In many other countries, once you're sick, you get diagnostics, right?
Blood tests done, scans, 'cause we wanna know exactly what you have, or we wanna rule out all these other pathologies. And I'm thinking, in those countries, there might be a monetary incentive but in the [00:53:00] Netherlands, that's not how it works. There's just this primary care system, and we filter things out, and we, we make sure that you're stable.
And if we can't figure it out, okay, then you go to a specialist, right? And, getting , my patients, the expats, to understand that is really, really interesting. And many times when I say, "Right now, it, I know you're worried about, let's say, the headache. I, I've heard everything you said. I've done my examination. I don't need to send you right now to a neurologist because of these reasons." And they're like, "Oh, okay, I understand that now." . And this is what I like doing, explaining the context, and getting them out of that perspective and making them understand how it works in the Netherlands, because I'm sure that by the time they leave the Netherlands and they go off to another country, it will be a completely different perspective there too. But at least here they understand how it works.
Sharee Johnson: Let's talk about the AI tools and the workflow tools that you're, you're using. Um, that's a bit of your entrepreneurial spirit as [00:54:00] well. But it, but it's also- Yes ... come out of your own frustration, hasn't it, in terms of, the administrative burden and the work that's involved in this, filtering and assessing and, all the differential work that you're doing as that front line in primary care.
Dr Sabine Fonderson: The AI tools have come because I love everything that has to do with digital technology and gadgets. As a young kid, my dad, like I said, my dad used to travel all the time, and when he came back home, he had, like, the latest Walkman, and then it was the latest CD player. And every time he had something and he, it was, like, a year old, he would give it to me. So I always had new gadgets. Okay. Um, for me, AI, now that we have... We, we've always had technology, right? That's, that's never changed. It's only becoming more advanced, and now we have this thing called artificial intelligence, and the, the way I [00:55:00] see it is that it helps me, uh, do things a little bit faster. It helps me do things a little bit more efficient.
And the way I explain it to, to my team or to, to anybody is I say, "AI has helped me get all this data, which is quite unstructured, into more structured data that I can do something with." Mm-hmm. Okay? And the tools has helped me then tell my patients, "Okay, I now have enough, the possibility to look at 20 years of your data.
It would take me maybe four months to go through all of it and make sense of it, but now it takes me a few minutes. What would you like? Would you rather that I do that for you so that I can really find out what's going on? Because 20 years of data can really help us understand you better, or I just basically, you know, upon reflex just treat you.
Every time you come in with something, okay, we treat that." And I want us to use AI to do that more. Mm-hmm. Let's look at all that data and make it more structured [00:56:00] to, to be able to make predictions regarding that one patient.
Sharee Johnson: Hmm. So you're really talking about personalized medicine. How, how are the- Yes people around you responding, are the patients and your colleagues? Are, they agreeing with you or are they scared? What, what's happening?
Dr Sabine Fonderson: It's a mix. It's a mix. I can tell you honestly, in my practice, I've had team members leave and they say they don't, see themselves in that vision.
Uh, because it is a vision that I have and I want to implement, so they've left. Um, so I've had team members leave because they don't see themselves in that, in that vision. Um, I've had team members say, "Wow, um, this is great. Finally," you know, "we can actually use tools to, for example, send out questionnaires to patients."
I'll give you an example. Um, in the Netherlands, if you are in a chronic care, uh, condition, for example, heart disease, COPD, asthma, diabetes, you are part of a [00:57:00] chronic care pathway, and we get subsidized by the government to take care of you. And it means that we call you up once every four or five months to see how you're doing.
And we've realized that there are certain questionnaires that we can send to you at home and you fill it out, one of the criterias for getting that, government funding is if we comply with certain data, 'cause they want that data to be able to make sure that we're doing our job. So imagine the, the workload that we can take off a practice by using just an easy tool like a Microsoft, form that a patient can fill out by themselves at home and send it to us, and we now have the data that we can insert into these care pathways, and we've done already 40% of that work. But what happened in the past is that you would have to block a whole 30-minute slot and have the patient come to you, and I'm thinking, "How, how efficient is that," right?
Because [00:58:00] that 30-minute slot doesn't change anything, 'cause you're still gonna get the funding, but you're really taking away time from other patients who might need you. So we are take- we're implementing all these different tools now and - we are actually instead of being more narrow in our workflows, we're now broadening our workflows because we get the data earlier on, patients are responding, we can ask them other questions.
We can do a lot more with that data than having to wait six months, right? And then six months later they've come down, sit down, and in, in that 15 minutes or 20 minutes slot, you have to do so much more work. And they forget things, right? People forget things all the time. So you're, you're not capturing the information that you should have captured six months ago.
You're capturing information that they just remembered a week ago. So we're doing a lot more with information to make sure that we really help patients. So we've got a mix of, uh, of responses. The majority of my peers, they think I'm, I'm completely [00:59:00] cuckoo, right? They're like, "What? What, what are you doing?"
Um, no, th- uh, because to, to be honest, general practitioners and most doctors are very conservative- Mm ... and they don't like change. Like, don't tell them to change their processes. "We've been doing this for 25 years. That's how it works. We're not changing." And I, I say to them, "Good luck to you," because it's not even because I'm doing it, but this is what the government is actually expecting from us to do.
There's a huge shift. The government is wanting changes. They're wanting innovation. There's a lot of funding, a lot of, you know, focus on innovative healthcare. So I say to them, "You know, you, you, you might as well admit that this is the way forward. Don't... Yeah, don't deny this." And I'm just happy- Mm ... that I always wanted to do this, so it comes very natural to me.
Sharee Johnson: Yeah. So you're an early, you're an early adopter by the sound of it.
Dr Sabine Fonderson: Absolutely. Yeah, absolutely.
Sharee Johnson: And it's exciting to you. I can see the energy in you as you're, as you're talking about it.
Dr Sabine Fonderson: I [01:00:00] took a course a year ago. I literally locked myself for a whole weekend, from Friday to Sunday., I told my daughter, "You are spending time with your dad. It was a, full-on weekend on everything about AI, and my mind was blown. I, I just thought, "We are so behind, okay?" It's a very fast moving. Yeah.
Sharee Johnson: I, I think we're in that, - delicate time of making sure that we're using the tools, not becoming the tool. And and so that-
Dr Sabine Fonderson: Absolutely ...
Sharee Johnson: that's the, that's the education that we need all of us to, to give ourselves and give each other. Your example is really reminding us that there is still choice, that there will still be moments where you're saying, "I really need to see this patient," or where the patient is saying, "I really wanna see the doctor." And then there are other times where there can be these streamlined workflow things.
Um, and change is hard for people. Actually, change, the going forward is not so hard, 'cause we like novelty. We're usually excited about novelty. It's the, uh, it's the letting go of the familiar and the predictable and the routine that's hard for humans. So keep up your good work with [01:01:00] negotiating with your colleagues.
Dr Sabine Fonderson: And I just wanna say something about letting go. I've, I've never said to them, "Let go of your routine." Yeah. I want them, because familiarity is good. Mm. I'm saying take that familiarity and then now add on to what this tool can do to make this, what's familiar to you, be more efficient. Just one small example.
I have a, a colleague of mine, unfortunately she had a shoulder injury, and she's trying to get back to work again, and her, her task is to go and visit patients at, mostly in their homes, especially, uh, vulnerable elderly patients. We spoke the other day and she said, "Sabine, uh, you know, I'm really struggling with my energy. When I get home, I'm exhausted." I'm like, "What's making you exhausted?" She's like, "Well, I see all these patients, and I come home and I have to type it all down in the patient notes, and my shoulder is really hurting me, and it just, you know, drains my energy." I said, "But I have a tool," right? "I have a tool that you can use whilst you're there. You can ask permission, 'Can I transcribe it?' Uh, 'Can I [01:02:00] record this?'" Of course. Just, yeah, just, and then you just upload it in this tool. It makes a beautiful summary and, and then you ... I'm not telling you to just copy everything blindly. Read through it and make the changes that you need, but it helps you remove all that pressure to come home and type all these things out, because that's a lot of energy. Mm. And she was like, "Oh, thank you so much. That will help me a lot." Mm. So she has, she's not been, she's not, I'm not asking her to change her, you know, her routine. I'm just asking her to look at what works for her and how we can preserve her energy so that she doesn't get drained. The last thing I want is for her to leave.
Sharee Johnson: Yeah. Well, it's that running an experiment, isn't it? It's being willing to, to test and trial. Yes. And, uh- Yeah ... a very important point that I wanna just amplify, that, um, there i- there is some, uh, evidence that doctors do become complacent with some of the scribing tools, and so I really like that you reiterated that, you know, still read the notes, still make the changes.
Ultimately, you're still responsible for the [01:03:00] notes. Um, so- Yeah ... that's this idea, again, of using the tool to support and help you, but not giving over your responsibility to the-
Dr Sabine Fonderson: Yeah. Yeah. Yeah. And I'll tell you something, just 'cause I really like the way you said it. I built the tool myself, so it's not something that I bought. I built the tool. And I made the tool purposely, And this is a true story. I made a tool that it, does not discern whether or not it's a male or female. Mm-hmm. So when it, when it gives you the summary, it's always by default male. So you have to actually read the, the summary and change things, uh, to
So i- I'm pushing you to make sure that, because you can have a female that you saw, but the summary will be default male, so you have to go in there and make some changes. So this is one of the things I did on purpose, yeah.
Sharee Johnson: All right, I'm really conscious of our time. We've had such a lovely- No, it's okay.
Yeah ... good time together. Is there anything that while we've been talking that, you know, y- has come to mind that you wanna reflect on or point to or, you know, emphasize, maybe for our younger doctors or for our listeners who are feeling nervous about AI, or our doctors who are [01:04:00] feeling like, "Oh, I can't have all this variety in my life"?
The thing that's really obvious talking to you is the variety, that you're honoring your desire for variety in your life. Anything you wanna put a pin in before we finish?
Dr Sabine Fonderson: Well, I want to take a moment to thank you, uh, Sharee, because when I reached out to you back then, I was really struggling, um, with where my path and my career was going. And I remember reading your book, and I remember thinking to myself, "It's okay to find, to seek help." Mm. Um, and I want to reiterate the fact that just because we're doctors, we are humans and we suffer, and a lot of doctors suffer in silence. And I think this is one of the things that, again, the system has done completely wrong by not allowing a space for vulnerability, by not allowing an open space for talking about vulnerability, mistakes, [01:05:00] um, anxiety, uh, frustrations, anger, 'cause we deal with so many emotions from other people, and they expect us to just take it all in, okay? We're the filter, right? I have to take your emotion today because you're just angry because you had to wait 25 minutes before you got to talk to me. I have to take your emotion because you're angry because I didn't, prescribe a medication. There's a lot going on. And the system has to change.
But sometimes the system isn't ready for that change because it likes the status quo, right? But I want to reiterate that as doctors, please remember that you are humans first, and your body is telling you every day what's wrong and what's right. And your coaching, what you're doing, that recalibration, is helping us understand how to connect with those internal signals.
And sometimes external signals are also being, uh, brought up by people around you. [01:06:00] I've had my father say to me, "Sabine, are you okay?" You know, "When I talk to you, you sound really exhausted, make sure you, you rest." Your partners are telling you things. Your children. My kid told me, remember, "Mom, you're really negative about work nowadays.
Maybe you should think about your mental health." Those signals are real. So what you're doing is amazing, so I really wanna highlight that doctors, people, health professionals, please, you are human, vulnerable. And I say to my team, I always say to them, "I want you to take, put yourself first before a patient."
And I do this on purpose. I say because if you're not good, you cannot treat a patient. And this is an anecdote. Everybody's like, "Oh, this is, everybody says that," but it's the truth. Mm. And that's why I'm no longer ashamed to tell my patients, "Hey, look, today I'm really tired. I can't take care of you. But good look, my, my colleague is more than happy to take care of you."
And it's okay to do that because the worst thing that can happen is that you [01:07:00] push yourself, you push yourself, and do things that your body's telling you, "I'm exhausted. I can't anymore." But you do it because society says, the system says, and then you make a mistake. You make a blunder, and then what? Yeah.
Um, I, I, we need to have open dialogues. That's why I, I, I talk about many different things, but I highlight you have to put yourself first, period. Mm. And I even say, said the other day, w- I was having a conversation with my accountant about, like, like I told you, I'm now really getting into my business side of my, of my practice, the financial health of it, 'cause everything has a health, factor.
A business has a financial health. A business has a, process health. You gotta look at it, things like this in these systems. We were going back and forth about something, and I remember saying to him, 'cause I put my... My daughter came in my mind, and he said, "Oh, well, you're spending a lot of money, , in hiring, you know, personnel," 'cause I have a big team.
"And if you look at it, for the number of patients [01:08:00] I have, it doesn't make any sense." And I said, "No, I do that on purpose because I wanna make sure that I'm home." With my child. I remember saying to him, "This is non-negotiable," you know? Yeah. The things that I do for my kid, and for her and me, and for us, is non-negotiable.
And I want, I, I challenge doctors to start saying, using words like this. This is non-negotiable time. When, when my shift is ending, 'cause that's what I have on my contract, non-negotiable, I'm out. Dare to say that, okay? That, that's really one of the fundamental things I want people to understand.
'Cause the system is there to make us work, work, work beyond our limits, but sometimes those, that limit has to be non-negotiable. Yeah.
Sharee Johnson: That is a beautiful place to finish. I hope that every listener has really heard that last bit. Non-negotiable, I'm out. The time is up. Yeah. Finished. I've got some other life to live now.
That- Absolutely ... that makes me a better doctor, actually, when I go off and do my other life, so. Yes. Mm-hmm. Thank you so much, [01:09:00] Sabine, for being with us today. Thank you. A joy, as I knew it would be, to talk with you. I really look forward to when we get to release it out into the, uh, into the world. And, uh, we certainly will be pointing people to your TED Talk.
I hope if you're listening today- Oh, thank you ... um, that you go and look up, uh, TED Talk, Sabine Fonderson, and, uh, really spend some time reflecting on, what she shares in that TED Talk about the art of medicine, the craft of medicine, and the history of medicine. We are sometimes caught up in what's going on in the moment, , that we're operating in.
Giving that historical context, I think, also has really helped me think a lot about those, those themes of the art of medicine. So thank you, Sabine. I look forward to talking with you down the track. Maybe not, uh, so long in between talks.
Dr Sabine Fonderson: I'm still coming to Australia, I promise, yes.
Sharee Johnson: Yes. Well, there's, there's one continent you haven't been to yet.
Dr Sabine Fonderson: Exactly, yeah. Okay. Absolutely. Thank you. Awesome.
Sharee Johnson: Thanks, Sabine.
Speaker View-1: I've got so many notes here from this conversation with Sabine that I'll need to refer to them to make this little [01:10:00] wrap-up. And wasn't it a powerful finish when she said, you know, "Dare yourself to say, 'No, I'm out'"? Sabine's, story is really full of opportunities to recalibrate and perhaps earlier in her career they weren't as conscious, but certainly in these, this part of her career, really conscious decisions where she's seeking feedback, she's having some coaching, she's noticing the signals from her body. I hope you also heard that message, that your body is giving you signals and other people, your partners, your parents, your, your kids are saying, "Are you okay?" Or noticing that you're not okay, or noticing that you're somehow different. This opportunity to be really consciously choosing and then accepting the consequences.
You know, I think when her accountant was talking to her about taking on more staff, and she was saying, "Well, I want to have more time with my daughter." You know, she's buying back her time. And the thing that really resonates with me is this agency, this [01:11:00] ability to decide that I've got choices, and I'm going to activate some of them, and there are consequences, there are costs. Which ones am I willing to, suffer in this part of my life, you know? And she's saying, "Well, I'm no longer wanting to be away from my daughter or my family or these important occasions." And the price of that is to have more staff, more people in my team. And really, uh, accepting that with responsibility.
I, I really love that example from Sabine. She also ... We also talked about this self-leadership. I hope that you can spend some time reflecting on that idea. Before we can lead anybody else effectively, we need to be able to lead ourselves. And self-leadership requires acceptance, openness, experimentation, a willingness to be wrong or to fail, uh, and to try something else, and I think Sabine gives us some really good examples of that.
She, also talked about, that global perspective, and I think she really is unique in some ways in that she has [01:12:00] worked across many different countries, including in Cameroon. Uh, did you see her eyes light up when she talked about her passion project? I mean, such purpose, such heartfelt connection to that project and, huge ripples.
And then she said and when her aunt was no longer able to do it with her, it sort of lost some of its, uh, excitement. I think also she, you know, she had a, had a child and other things were happening in her life. So being able to look at our lives as chapters, to have value and excitement and regard for ourselves about the things that we've done, even if they have finished or they weren't able to be ongoing.
Earlier on in our conversation, Sabine talked about asking herself that question when she was in the NHS, work- working in the NHS, "Can I sustain this for another year?" I think that's an interesting question, too. You might have your own version of that. But this process of checking in and saying, "Is this working for me? Is it still working for me? Can it be working for me? When's the next review period that [01:13:00] I might set up?" So a lot to take home. I'm still chewing on a lot of the things. I hope Sabine and I actually can do another episode in a year or two. She's got so much experience to offer. She's such a willing participant in, adopting the new technology and looking for ways to make it really personal to what she needs.
I hope that you, also have found some things to think about and maybe take some action on after listening to Dr. Sabine Fonderson.
May you be well, and I'll see you next week
[01:14:00]
