Recording Podcast (Vijay Roach) with Sharee Johnson
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Sharee Johnson: [00:01:00] [00:02:00] Today's conversation is with Dr. Vijay Roach, who has worked for 35 years as a obstetrician and gynecologist. Vijay has been the, president of RANZCOG. He's chaired the President's Council in Australia, and, has really a pretty good long-term helicopter view of what's happened, at least in his area of medicine.
And we talk about Vijay's own family as well, and his experience of becoming a parent, uh, with his wife Cathy, and, uh, how they really got to understand perimental health and the journey of, learning to balance being a professional person in the world where you have standing and regard with who you can be at home, and those different roles, what they require from us.
Vijay is generous in his, conversation and reflection about medicine as a profession and [00:03:00] about being a man, a human in the world trying to navigate all of the things that life throws at us. has said yes to a lot of opportunity in his career. I think if you're a young doctor listening to this, it'll be interesting to reflect yourself on what you want to say yes and no to.
There have been, of course, benefits to that and, there are also some downsides. I think this is a really realistic conversation about what's involved in those choices of saying yes and no, beside your clinical practice, and beside having a family. I hope you enjoy this conversation with Dr. Vijay
It's my absolute privilege today to introduce you to Dr. Vijay Roach. Vijay has 35 years of clinical experience as an obstetrician and gynecologist. He has held a number of senior board positions, including the president of RANZCOG, the Australian and New Zealand College of Obstetricians and Gynecologists, and he has been the chair of the Council of Presidents of Medical Colleges here in Australia.
[00:04:00] He was the inaugural chair of Gidget Foundation Australia, and has remained consistently involved in advocacy for perinatal mental health care in Australia and internationally. He is passionate about the importance of kindness in medical practice, and, uh, that's how Vijay and I met in 2014 when I invited him to come to the Gippsland Health Summit many years ago, and he very generously came from Sydney to rural Victoria to Sale to be a part of that.
And you're here again today in kindness Vijay, it's lovely to see you. Welcome.
Dr Vijay Roach: Thank you. Thanks for the opportunity, Sharee
Vijay, you've had a long career in medicine, and we'll go back into history in a little bit. But can you tell us a bit about your, you know, what's an average month look like at the moment for your medical practice?
So you think about trying to slow down a little bit, and that doesn't seem to happen, I think, at this stage in your career because there are so many opportunities. So I'm still a very busy clinician. I practice gynecology now. I stopped obstetrics about five years ago. But [00:05:00] gynecology is also still very busy with long consulting days, then having to do your dictating and checking your results and following up and that sort of thing.
I'm also involved in medico-legal work. Mm. And I find that very interesting because it's being an expert witness where your duty is to the court. I think that doctors often perceive that there's a legal system that's out to get them, but in fact it's recognizing that if somebody comes to harm, we need to find out whether there were actions that were taken or not taken by the medical system that might have contributed to that harm.
And so I give an opinion. I don't think that doctors, uh, never make mistakes, and I don't think that doctors always make mistakes. You read the materials and you give an opinion, and then you leave it to the court and the legal system to work out whether, you know, blame should be apportioned or whether a plaintiff should be successful.
And then the other work that I do, which is really interesting and, and, and a variety of sort of opportunities, uh, working with organizations, [00:06:00] looking at the culture of medicine, looking at the way that doctors are impacted by complaints or legal, uh, suits, looking at the, the way that the system treats doctors and ways that that can be improved.
And so I find that quite interesting to have that opportunity, which also came through the college work of taking a bird's-eye view. So working at the coalface and being a bog standard clinician who sees patients and looks after patients, but also stepping back and having this broader systemic view.
Sharee Johnson: Mm.
Can you tell us a little bit more about that, Vijay? How, how are you looking at the system? What's the mechanism and I guess what are you noticing?
Dr Vijay Roach: I, I, I think that there's a sort of mantra that the system's broken. I don't think that that's helpful. We have an excellent medical system in Australia.
We have a robust public system and a robust private system. I think that s- just, uh, my societal observation is that we all work very, very long hours. Australians seem to work longer hours really than [00:07:00] many other countries. That we're stressed and we're tired, and that the system isn't supportive in that there isn't a kindness in the system.
And then what that leads to, I think, is a lack of kindness amongst colleagues, doctors to doctors, doctors to nurses, and then potentially, and importantly, that can then have a patient impact. And so I think that there's a need to step back and realize that you can't get blood out of a stone. You can't keep on pushing doctors just to work and to work and to work.
And we need to find better ways of working. We need to find opportunities for doctors to have more time off. We need to be careful not to say that it's all the system's fault because doctors also can make their own decisions about their work-life balance, not a particularly useful term, but how they might distribute their time and, and encouraging doctors to find, uh, outlets that are outside of work.
But I think that the other [00:08:00] really important thing is to work on changing the culture so that you have a spirit of kindness towards one another, of understanding, of appreciation for the difficulties or, or challenges that someone might be experiencing. But then the system needs to be able to support those people when they're in need.
Sharee Johnson: Are, are you making these inquiries through, through the college? Is that where that work is happening?
Dr Vijay Roach: Yeah, so I've had the opportunity to work with the HCCC in New South Wales. There's an organization called the National Leadership, uh, Alliance, which is a group of all interested parties in medicine looking at the culture of medicine. It's speaking at various conferences, it's engaging with the different colleges. It's just a constant thing. You, you wanna be having those conversations all the time and looking for, to bring up those matters whenever you can.
Sharee Johnson: D- do you feel like these conversations have been going on all through your medical career in some way, Vijay? Or do you feel like there's a new, [00:09:00] in the last 5 years, 10 years, 15 years, has that developed, this idea of talking about what we're asking doctors to do or their wellbeing relating to their capacity or... is that new, or has that been happening somehow all the time?
Dr Vijay Roach: That's such a good question, and unfortunately the answer isn't necessarily one that everybody wants to hear, which is we've been having these conversations forever. Mm. And so actually it's quite hard to keep dragging yourself back to the table and having the conversations yet again.
Mm. And wondering at what point in time things are gonna change. Mm. But I think what I have learned, when you're younger and when you're fired up and when you think this is all terrible, you think that there's gonna be some seismic shift with the work that you do. And then I think as you get older and you've been-- and you've heard the same conversation over and over and over again, you either become completely cynical and say it's all a complete waste of time, or where [00:10:00] I've arrived at is an acceptance that by doing the work that I do, the work that you do, you shift the dial just a tiny bit.
Yeah. And that's human progress. So yes, I do think that these conversations have been going on a long time. I do think that there has been a change in which there is a recognition that doctors can have mental health problems, that doctors struggle in their own way, whereas before we were considered a profession that was unaffected by those things and that we were completely resilient and we can cope with working 100 hours a week, and in fact that was a good thing and it demonstrated what remarkable human beings we are, to shifting that to saying, "Actually, we're just normal human beings, and so therefore we're susceptible to all the challenges that every other human being, including our patients, are susceptible to, that we're no different from them."
Mm-hmm. And that's a good thing. There's a general societal discussion around mental health, and I know we'll go on to talk about perinatal mental health, but specifically the conversations we have around perinatal mental [00:11:00] health never existed 35 years ago. . So that's a shift, and I think that by continuing to talk about it, even though you won't see the world change overnight, at least you can have a sense that progress is being made.
Sharee Johnson: Mm-hmm. Incremental change. Let's go back 35 years ago, Vijay. So, um, how did you find yourself in medicine? Did you know that you wanted to go into medicine when you were at school?
Dr Vijay Roach: No. No. The, my passion was, uh, animals and I loved all the, the books that James Herriot and Gerald Durrell and I followed David Attenborough and that was what I wanted to be. I wanted to be a vet. I wanted to do large animal work, that I would live on a farm and that would be my life. And it was a chance conversation during my high school certificate where someone was talking about some work that they were doing and it was like a light bulb where I suddenly decided actually the thing that I wanted to do, [00:12:00] or in a sense my responsibility was, it felt vocational, was to change the world, to have some impact.
And that if I was gonna do that, then the most powerful vehicle by which to do that is medicine. 'Cause I think that doctors are, as a profession, and as individuals, but as a profession, very, very powerful and able to influence social discussion. And so I decided therefore I would study medicine. I had no particular love or interest in medicine or that science.
Mm. And I remember the first day of medical school where the terrible things that people do, you know, the ... where do they s- get you to meet? They get you to meet in the anatomy museum. And I walked into the anatomy museum, and on the wall was a row of heads in jars. Yeah. And I thought, "This is a really bad idea."
And I went off to the university counselor and I said, "I think I've made a terrible mistake and I definitely shouldn't be a [00:13:00] doctor." And, and this counselor said, "Well, if you are going to continue in that position, you are taking a position away from somebody else who wants to be a doctor." And of course, that got my back up, and so I therefore became determined that I would become a doctor.
And, um, you know, five years later, despite failing most of my exams and being voted by all of my friends as the least likely to succeed, I did qualify in medicine. And, uh, and then once I qualified and had the opportunity to be a clinician, then the clinical aspect of it actually did grab me. So I really started to enjoy it. And I enjoyed the science of it. But in particular, and I think this was consistent with that whole theme, if you like, and consistent with my personality, was I enjoyed the relational part of it. Mm. I think my love of medicine or being a doctor, apart from that original, uh, using it as a vehicle to try and affect change, but for me on [00:14:00] a daily basis, clinical medicine gives you the opportunity to be relational in, with people in a way that nothing else possibly could.
Sharee Johnson: Except being a psychologist.
Dr Vijay Roach: Correct. And I wouldn't take away from that. Except, except ... And a- and the, it's not pushing back on a psychologist or it's not trying to compete. No, no. But I think that the community has a perception about doctors which is, is different. Mm. And when that really works, the level of trust and engagement, and maybe being a doctor also gives you a broader engagement.
And I think quite specifically being a gynecologist is that the things that impact women, and this is my observation, the things that impact women are ... they're sort of integral to their whole being. And it's not just the physical manifestations, but that then affects [00:15:00] their whole sense of self. And so if you're interested and if you decide that you're going to engage with that, or of course the patient chooses to engage in that way, then you can reach a connection with that human being that I think is really quite remarkable.
Sharee Johnson: Yeah. I mean, there's certainly an intimacy in it. I think that this element of intimacy and trust and, you know, um, talking about the physical, to use some old language, the private parts of your body and your experience. It's a pretty, special, relationship for sure. Um, so you thought you were going to be a vet.
You came to uni, and you found all the heads in the jars, which I just can't imagine, Vijay. Um, now I'm saying thank goodness I'm a psychologist. Uh, you know, so that was a recalibration already that you were recalibrating from thinking about being a vet. But this, ... I think you said a vocation, this core sense of purpose that I want to be able to effect change in the world.
Do you feel like you've been able to? Has being a doctor facilitated that desire?[00:16:00]
Dr Vijay Roach: Yeah, I do. I think that the, the opportunities will come. And I think it's important to be clear, it wasn't that I thought I was the person to save the world. Mm-hmm. It was more a sense of a, a need to serve. That was what your purpose was, is, is to, to serve.
And I think that that's what medicine provided me with the opportunity to do. With an individual who's in front of you, to serve her, And, and look after her and care for her and provide her with the medical care that she required. To then have the opportunity because of that position and the connections that came with it, to serve in organizations or in, in roles.
And it turned out that those roles then became leadership roles. And not for any particular reason. Maybe there are a set of skills that are related to being a leader. Uh, maybe it is a personality thing. Maybe it's a, a desire to, to lead. Uh, but [00:17:00] those opportunities certainly came up, uh, repeatedly, and I took those opportunities.
I found them interesting. I found them challenging. I enjoyed that role. Sometimes you don't enjoy it, because it can be enormously stressful being in a leadership role. And, and, and that sort of leadership role that a doctor takes in the nature of their relationship with a patient as well can be enormously stressful, because you can have self-doubt.
You can wonder whether you actually know more than your colleagues or whether that person might be better off being looked after by someone else. So that's something that one has to, um, have a degree of humility, but also learn not to be humble to the point where you, you're sort of incapable of doing anything.
Sharee Johnson: Immobilized.
Dr Vijay Roach: Yeah. That's right. And so, but I enjoyed that opportunity to then... And the other thing about, I think, leadership roles, is that you've got a seat at the table as well. So you actually have the opportunity to find out how systems [00:18:00] work, how government works, to interact with the change makers and the decision makers, and that becomes really fascinating.
And you get a better understanding when we circle back to what we were talking about before, about the problems with the system. Mm-hmm. Is that you actually start to understand why some of those problems are impossible. Hmm. Uh, or far more challenging than they appear when we're sitting in the armchair being critical about it.
Actually- Yeah, you're really, you're- ... it's not that easy ...
Sharee Johnson: you're really in the arena, aren't you, as Brene Brown- Mm ... would say. And so, um, so you came out of med school and you found this, actually there are things here that I, you know, really want to engage with, and, and particularly the, the interactions with all the people.
I, I think that's really underestimated in medicine, this relational component. I don't think the teaching is quite right, and that's a very broad statement. Obviously, all the medical schools are a bit different. And science is very seductive. You know, science is kind of the new religion of the day, and so gets a lot of air time.[00:19:00]
How did you decide to do obstetrics and gynecology? Was that a difficult decision?
Dr Vijay Roach: It wasn't difficult. It was easy in the sense... And I've reflected on this so many times because I used to have that line that I enjoyed working with women, and going back to what we were talking about. And that, you know, or that obstetrics and babies and all of that sort of, you know, part of people's lives was so enjoyable.
But I think actually, and this will be in terms of advice to a junior doctor who was thinking, "Where do I wanna be or what do I wanna do?" There can be the, I find that aspect of medical practice really fascinating. But actually, I think that eventually wears thin because you've done it before. And it sounds, to someone who does not deliver babies, it sounds outrageous that one might think that you could arrive at a point where delivering a baby is a sort of relatively ordinary event.
Obviously not for the person that you're looking after. [00:20:00] But when you've got to 5,000 and 6,000 and 7,000, you've done it before. Mm-hmm. What I really, I think that the, the, the deciding point for me was that I really loved the work environment of obstetrics and gynecology. The doctors who I met when I was a medical student, who remain my close friends today, they influenced me.
The midwives and the interaction, the hanging around, um, on labor ward while, while we were waiting for things to happen. I really enjoyed being part of that community. And so that was what attracted me to being an obstetrician and gynecologist, as much as the subject material itself.
Sharee Johnson: Mm. I haven't asked you before, but has all your work been in Sydney or have you been other places?
Dr Vijay Roach: So we, I, was a medical student at Royal North Shore Hospital, which is in Sydney, and then I, uh, actually then went to a couple of other hospitals in Sydney and outside in regional New South Wales. And [00:21:00] then I, I did my obstetrics and gynecology training through Royal North Shore. And part of the rotations and opportunities that I took was a year in the United Kingdom and two years in Hong Kong.
And so I did three of my six years of training overseas. And I loved the work, and as a family, we loved that opportunity of being expats in, in other countries. That was, yeah, really enjoyable and formative for us as well.
Sharee Johnson: Mm. So there's probably 100 recalibration questions I can ask you about that, but I wanna keep moving and, and you're talking about the leadership opportunities.
We've talked before, part of why you've had a lot of these opportunities is because you've had a willingness to say yes. And I know that lots of doctors early in their career, particularly, uh, as registrars and then, uh, young consultants, feel a lot of pressure about having to say yes. And, and then, uh, lots of them come to coaching in their sort of 10 years in and go, "I need to learn how to say no.
I'm not saying no enough. I can't balance all these things [00:22:00] that I've got." What, what's your kind of reflective wisdom about I guess the benefits and, and if there were any downsides for you about, you know, the, the many opportunities that you've been invited to take part in and, and, and the saying yes policy that you've had?
Dr Vijay Roach: Well, I think that the saying yes policy has to be balanced, but it also has to be put against the outcomes that you want as well. So if I look to my pathway towards very senior positions or a successful medical practice, I'm not sure that you can have, "I'm gonna be selective about this, and I'm gonna have a reasonable work-life balance," and say, "And I wanna be president of the college as well."
Mm-hmm. 'Cause I don't think that that works. Now, I'm not saying therefore I think that everybody should work as hard as the person who will eventually become the president of the college. But in the same way, and we're [00:23:00] observing this, and I think every generation has observed the generation that comes after them, we're seeing that there is an expectation of earning the same income but working fewer hours. I don't think that that works. I don't think that that's reasonable. I wanna have a practice as large as that, but I don't wanna be available 24 hours a day. Well, you can't do that in private obstetrics. So I think that for me, I was interested and didn't wanna miss out and wanted to experience all of those opportunities that, that were there, so I kept on saying yes to anything that came along.
Not out of some sense of self-sacrifice, but because I wanted it. It was for my own needs that, and I found them interesting, and I found them rewarding, and I wanted to do it. And then as a result of being available, you know, the three A's, availability, affability, and ability. In the end, if you're not there, it doesn't count.
Doesn't matter how good you are. Mm. So that meant that every [00:24:00] opportunity that came along, I said yes to, and I think as a result of that, you become known as the person who will say yes. Mm. And then you get given more opportunities and more opportunities, and obviously you gain more experience as well, and so therefore you're more capable of making those opportunities successful.
Sharee Johnson: Mm. There's a snowball as well, isn't there, in terms of your network? You're just, you know, you're, you're visible and, and people get to meet you. Uh, it's not just a referral, people actually personally meeting you, and because you like relationship, because that's the kind of core thing for you, you're happy to meet people and talk to people.
I think a more introverted person is gonna look for a different kind of opportunity.
Dr Vijay Roach: Yeah. Yeah. And I think that that worked for me because I like that sort of level of interaction, and often those relationships would build into something that was more as well, and something that was sustained once the, um, engagement or purpose of the engagement had ended.
A lot of the friends that I have made [00:25:00] and, and continue to enjoy are ones where, yes, there was some other purpose that began it, and then it's continued because of that relational way of interacting.
Sharee Johnson: Mm-hmm. And so, um, the other parts of your life were developing too. You know, you said you were in Hong Kong and you had a family. You married Cathy and, um, you know, there was obviously recalibrations going on all the time in terms of, you know, adjustments to where you lived and how many people were in your family. You've got five children. So how, how was that? Can you tell us a little bit about how you adjusted to saying yes and having lots of interesting things to do, but also learning how to be a husband and a dad?
Dr Vijay Roach: That's the question, because I think the, the, the greatest limitation is capacity. You know, it doesn't matter who you are or how clever you are, you don't have more than 24 hours in the day, and you can't find more than 24 hours in the day, and you also don't have unlimited capacity as a human being. [00:26:00] And so there was a cost in throwing myself into that professional life and being so engaged with that professional life and all the opportunities that came with it.
While I had reward from that, and actually my family also had reward from that, not just financial and, and the lifestyle that we were able to afford and enjoy, but also they enjoyed the fact that their father was a successful obstetrician and, and everything that came with that. It's, it's nice to be that family.
But where I, I, I know I lost out was I wasn't mindful when I was at home. I was constantly waiting for the phone to ring. I was constantly gonna respond when the phone rang, and so that would mean that I was never present when I was with my children, and I regret that. I regret... No, I regret, regret the loss of the opportunity.[00:27:00]
And it was only many, many years later that when my oldest son was 15, and really just because I wasn't paying any attention, our relationship had deteriorated, and I actually thought it had just got to the point of no return, and in a weird way, I'd accepted it. Then I realized I hadn't accepted it, and so we went to a counselor.
And I still remember even the night and the evening and what she was wearing, and we walked in and I said, "I'm Vijay Roach. I'm a famous obstetrician and gynecologist. Everybody loves me. I'm very successful, and I have a son, and he has all of these issues, and that's why we're here, to sort it out." And she was almost like literally looking me up and down, and she looked at me and she said, "You know what? I think you could be the one who's got the problem." And I thought, "Okay." And, you know, nobody ever says that to me. And, and I do reflect back [00:28:00] because I was intimidating. I was, um, you know, tall and deep voice and male and confident and this successful human being, so no one ever took me on. And she did. And so we sat down and I thought about it and I thought, "Actually, I will accept this challenge."
And we talked about it, and she talked about the way that I spoke and, and the way that I talked to my son, and how really as a child he had no way of responding. And so we, I went home and I talked to him about it, and I talked to my other four children about it, and we... She gave us a whole lot of exercises, and we worked through it and, and it was really about learning how you talk to somebody.
And I realized also that that spilled over into my relationship with my wife. It spilled over sometimes into work as well, in the way that I interacted, particularly with midwives or with [00:29:00] junior doctors, and that it was a sort of way of putting people down and not making them feel good. And it didn't mean...
It wasn't coming from because I was a bad person. It was just a set of skills or a, a behavior that had been learned, and I needed to unlearn it. And I definitely don't think that, you know, I'm perfect and I've worked it all out, but it really was a moment of epiphany, and it did dramatically change the way that I interacted with my children, that I interacted with my wife, that I interacted at work, and I'm just so glad that that happened.
Because where it leads to, I have this thing that there's... the closest distance between two humans is humor. And what I mean by that is if you can laugh with someone, if you can tease someone in an affectionate way and they can receive that, [00:30:00] then what that denotes is safety. And what I got out of that whole experience in my relationship with my children, my relationship with my wife, people at work, and my patients, is that I want...
I learned that I wanted to, and I now absolutely want to be that safe person. I wanna be someone who a medical student feels that they can come and tell their story to. I met a medical student the other day. It was a remarkable experience in which I knew that she had failed a year, and th- that was the reason that she was...
But she was with a group, so we didn't bring that up, and she didn't know that I knew at that point. And she wrote to me afterwards and she said that for the first time she felt okay because she'd heard me talk about the fact that I had failed, you know, all of those exams, and unfortunately, that was the truth.
I passed them eventually, but, but that I revealed to her that I had had my own [00:31:00] vulnerabilities, my own errors, my own mistakes and development. And so therefore, that she was not alone, that she was not some weak person or inadequate person. And I thought if she felt that safety, that's an achievement. If my children feel safe enough to tell me what a terrible father I am, and that on, on Father's Day, they give me a card and suggest that I give it to their mother because she's the one who's looked after them, um, that they, you know, tease and, and they make fun of me, then to me that is fantastic that they feel that way about their father, that he isn't who he, who he was, was that scary guy who you didn't ever wanna push his buttons because he would react.
Mm. And so coming back to your question, I think that what I learned was that I, I was so consumed and busy and beyond capacity with all of the work stuff that I hadn't [00:32:00] paid attention to this, which was my family and my friends and the people who I love. And that once I did do that, actually it made everything better- Mm and more positive.
Sharee Johnson: I really want to honor the younger you, the present you that I'm talking to now, and the counselor. I think in that moment she was incredibly brave. Um, and there's, there was something in you that let that land, and that's a really, what a beautiful example of how to learn, we need to be willing to change.
We need to be willing to take some feedback and, and that we can't see ourselves. We can't see the whole of ourselves. We've all got blind spots. And, she gave you the opportunity. She opened the door with some feedback that was probably a bit tough to take in the first instance.
Um, and something in you actually allowed that to get in and to take some responsibility for it. , So I want to just honor that. And then to honor the, the you now who's sharing, who's, [00:33:00] you know, kind of shattering the myths of the guy who's got it all together. By saying, , the medical student's a lovely example of that where, where, uh, she's given you the feedback that because you shared more than one dimension of yourself, she was able to tap some other dimensions of herself.
That's, that's really powerful. Victoria Lister has been on the, podcast and she investigates the silencing of voice at work, particularly for junior doctors, and it's a very real thing. The research says it only takes a couple of times really for people to be shut down Um, for them to lose their voice at work and not speak up.
So I think what you're pointing to here in terms of learning the, the way to communicate in a way that creates safety so that people can share their vulnerabilities or their concerns when it comes to healthcare about an error with the patient care or, uh, you know, with a patient feeling bullied into a particular treatment that they don't want or, you know, this communication stuff is really important.
Dr Vijay Roach: Yes. And I think the other [00:34:00] thing that I learnt out of that as well, ... and that continues to be a lifelong work for me, because I think it's quite easy to be self-critical as well, counterintuitively. I think that, particularly people who have a large presence, people assume that they think that they're wonderful all the time, but in fact it's the opposite.
Often you do have self-doubt. Often you are, uh, be- because even though people aren't actually criticizing you openly, you're doing a good enough job of that yourself. Mm-hmm. And what I learnt out of that, and what I continually keep on trying to remind myself of, is that a flaw does not make you a 100% flawed person.
Sharee Johnson: No.
Dr Vijay Roach: You know, so you, you explore that flaw on its own. And so I have many flaws, but they still don't define me as a bad person. And so I've made mistakes. I have personality traits that, that need to be worked on and need to be improved. I have, um, been hurtful. [00:35:00] I've done all sorts of things, but inherently, I'm a good human being. I'm a kind human being. I'm a loving human being, and I need to keep on reminding myself of that, uh, and, and celebrating that and being grateful for that, rather than constantly coming back to, yes, you know, I, I did that or, uh, I was responsible for something that wasn't so good.
Sharee Johnson: So important, Vijay. This human condition, we're all flawed, and, being able to welcome these experiences is how we learn, how we look after each other. So, so beautifully put. Thank you. Um, so you've got the five kids. Cathy's doing a lot of the work at home. You haven't got the five kids yet. You've got a couple of kids and, uh, you know, you're learning about being a dad, and along the way, you meet, uh, these, this group of women, because you work in, in women's healthcare, who, um, have created something called, I don't know if it had this name yet, but have created something called The Gidget Foundation, and you get involved [00:36:00] with them.
How did, how did that all come about? Can you tell us that story?
Dr Vijay Roach: Well, there's a backstory before we even arrive at meeting, um, Gidget's family, and that was that unfortunately and sadly, Cathy and I, the, you know, the lovely obstetrician and his lovely wife, um, we had... We have five children. Only three of those pregnancies were unplanned, and the first two were unplanned.
Sharee Johnson: Okay.
Dr Vijay Roach: And amongst those first two, Cathy developed severe anxiety and depression, and it was undiagnosed, and the manifestation, and what I thought was the explanation, was a complete breakdown in our marriage and in our relationship. A lot of anger, um, and a lot of suffering on Cathy's part. When I would go to work, she would take the two children and put them in their cot, and then she would sit on the kitchen floor and rock herself, having suicidal thoughts.
And then I would come [00:37:00] home from work, and we would end up in a big argument. And contrary to how I might-- my sort of public persona of being this kind and generous and warm and loving person, in that environment, I didn't have, uh, that was not how I behaved. I was actually more impacted by the way that she was and had a negative reaction to that, and I would also become angry and raise my voice and, uh, and not be understanding.
And the reason why I talk about that is that I think that it's an important message that that's what happens in those circumstances. We all would like to think that if we're with someone who's hurting, particularly if it's someone who we're so close to, that we will put our arms around them and care for them.
And you do do that, but also because it impacts you, sometimes your behavior is not as you would want it to be, and mine wasn't. And after two years of what we really believed was just a dysfunctional marriage, a diagnosis was made of [00:38:00] anxiety and depression, and Cathy went into hospital and she had medication, and then we saw a counselor over the next five years, and we slowly clawed our way back.
And it was maybe 10 or 15 years later that, uh, Cathy met the people who were involved with Gidget. They were aware of me because I was an obstetrician. We had a chance meeting at an event, and they said, "Would you be involved in our organization?" Their organization began because Gidget was the name of a real person, um, her nickname, and she very sadly after the birth of her first baby took her own life because she was diagnosed with post- she was under-diagnosed and under-treated with postnatal depression.
And her friends and family were, were completely shocked. There was no sense that that happens when a young woman has a baby in this very happy environment of a loving family, a loving husband, [00:39:00] a vivacious, bright, happy woman consumed by this illness. And, you know, that was exactly what, what could have happened to Cathy and me.
And so they asked us whether we would be involved I said yes, because I say yes. Yeah. And, um, and he was, and it was something that, uh ... I really knew that Cathy had this enormous passion for, and we had had a lived experience of. And so therefore we, uh, had genuine empathy for their experience and a genuine desire to, again, shift the dial.
Mm. And with the Gidget Foundation, where I became the inaugural chair, Cathy became the inaugural CEO, we worked with Gidget's sisters and her family and her friends, and a committee of dedicated, talented, people. We helped to build that organization into a large organization. Our mission was to raise awareness about anxiety and depression.
And in that time, the 14 years that we were involved, [00:40:00] you saw that change in Australia, and the Gidget Foundation definitely made a contribution to that quite seismic shift. Mm. But we were also able to do other things. Cathy had the idea of introducing visits with psychologists that were fully funded, uh, through the system, and she mobilized those psychologists.
We established a concept which was a physical presence but really a virtual presence of Gidget houses, places where people could come to receive that counseling. And we spoke at any conference that we could. We were involved in the Perinatal Mental Health Guidelines for Australia. I was able to, because of a committee that I was on, help to change Medicare so that it, it is now compulsory to screen for perinatal mental health conditions in pregnancy and after pregnancy.
And we're the only country in the world in which that legislation exists. So it provided all these amazing opportunities to [00:41:00] really make an impact in what is a very, very important part of maternal health. Mm. And it connected us with really quite remarkable people, Gidget's family, Gidget's friends, people who we loved and admired and became connected with.
And together, you know, as a family if you like, we were able to do something that was really important and grow something and honor Gidget's legacy.
Sharee Johnson: Mm-hmm. And i, I do wanna talk some more about that, antenatal mental health, but before I go there, I've said to you before that, um, this is how I came to know about you, that you were talking at a RANZCOG conference about yours and Cathy's experience and, and other doctors were saying, you know, "Who is this person who's talking so much about their personal life?
Doctors, you know, doctors don't do this, and you're up on a stage doing that." So,I think the way I asked you, um, in previous times is was it scary to do that? Was that a risk on your part? How did that feel as a, as a leading [00:42:00] senior doctor at that stage to be, albeit, you know, some years before, but sharing this really personal story?
Dr Vijay Roach: It is always, and it remains a risk even in having this conversation with you because what does a human want for themselves? They want people to like them. Mm-hmm. There, there's no way... When people make that statement, "I don't care what people think," that's just completely untrue. We all care what people think.
And so we make sure that our hair looks okay, you know, when we're gonna do a podcast. We're, we're, we're thinking about the way that we present ourselves and the way that we will be perceived. For me, I think that I felt so strongly about this issue, I felt so strongly about what had happened to Cathy and to us and to Gidget and her family, that you can't let that happen to another human being.
We know that suicide is either the [00:43:00] leading cause or one of the three leading causes of maternal death in Australia and in every other country. Mm. If people are unaware of that condition, those suicides are gonna occur. Mm. And let alone all the other harms that go with ... And it's not just about mental illness, it's about impacts on the infant, it's about impacts on the, their family and the community around them, and the workforce.
I mean, it, it, it's, it is a profound disease. Mm. And so therefore, if the cost of that is in some way exposing my vulnerability, if the cost of that is that people might perceive me in a negative way because we went through that experience, then that was not something that I felt concerned about, ultimately, because I thought that that was more important.
But I think what I also grew to realize is actually people don't think negatively of you. People are actually [00:44:00] grateful because they share. And I still see that experience in my current clinical work, which is when you're talking to someone, and now I'm of a certain age and I'm looking after women who are of a certain age, and they'll come in and they're overweight and they're struggling to lose weight.
And I say, "When you work out how to do it, make sure you ring me as well, because every morning I go on a diet, and by the time I get home, that one's gone. And next week I'm going to improve my steps because I can't do it this week." And, and going back to that humor thing, you know, my patients, when they come back for their follow-up, they go, "So how are your steps going?"
And they, they, they want to know about me. But it, it, I mean, I'm not any different to the people that I'm talking to. Mm. And so sharing those experience, I think normalizes so many of the experiences that we have, and it makes it, um, again, that safe environment- Mm ... because those [00:45:00] things are shared. And when it came to perinatal mental health, the audience that you're talking to needs to hear that this can happen in anybody's home.
That it isn't a particular type of person, that it isn't a socioeconomic group, or it doesn't depend on your level of education, or it doesn't depend on whether you're a good person or a bad person, or whether the pregnancy was planned or unplanned, or any of those things. That this is a disease that doesn't discriminate, and it didn't discriminate when it came to people who were educated, intelligent, had plenty of resources.
Um, it, it, it still affected us.
Sharee Johnson: Mm. Yeah, so let's just stay here for a minute, Vijay. What do you want the audience, it's predominantly a healthcare audience that's listening. I can hear some really important messages in what you're saying about, you know, we're human too, and these things can come up for anybody.
W- what do you want people to understand about [00:46:00] these illnesses? What, what do, what are the things that we really need as a community to keep talking about?
Dr Vijay Roach: Is that I think that we, uh, we're all potentially going to be impacted by physical ill health or mental ill health, or just the vicissitudes of life.
You know, that these are things that no one is immune from. Mm. And that's okay. Mm. That that just- It's real ... makes you a human. Mm. Yeah. Being a human sometimes is really hard. Mm. Learning how to be a good parent, or a good partner, or a good friend, or to live with yourself, to, to do all the things that we now sort of make a moral judgment about of being fit and, um, and not eating too much, and not smoking or drinking or taking drugs and, and putting some kind of moral imperative on that.
I think that it's important to communicate the fact that you're just a human. [00:47:00] Mm. And interestingly, I think that in the past, whether the profession created it or whether the patients created the expectation, we did have that thing where a doctor is something that's just above the rest of us.
Sharee Johnson: Yes.
Dr Vijay Roach: And I don't think that people feel that need anymore. There's a democratization of information. You know, we used to say, "Oh, you know, she Googled her symptoms." Well, now if she looks it up, actually she's gonna have a pretty good idea of what's going on, and then your job is to help to facilitate that.
Today we had someone come and look at a small area of the house that we want to do something with. We know what it is that we'd like to do, but he was able to point out that if you move that wall, the whole house would fall down. So it wasn't as though we were silly, or we didn't know what we were talking about, or we had no perception, and I think it's the same healthcare as well, is that if we see ourselves as normal human beings, then people will respond to us as normal human [00:48:00] beings.
They will still, respect and appreciate our professionalism. But I think that if we see ourselves as normal human beings, we sort of liberate ourselves as well. We don't have that sort of constant pressure and, uh, sort of weight that says, "You've gotta be right. You've gotta know everything.
You're not allowed to be tired. You should be able to get out of bed in the middle of the night. It doesn't matter if you don't have lunch or if you miss out on seeing your family." Well, no, those things are important, and not only is there no way you can be human and not have those things, but also it is a reasonable right for a doctor that they're not doing it in an angry way.
They're just doing it in a human way of saying, "These are my limitations."
Sharee Johnson: Mm. Yeah. I think you used the word capacity before, that we know that these things improve our capacity, and we could take capacity out and say energy. That, you [00:49:00] know, our energy or our availability or our presence, uh, improves if we remember that we're human, and we need to eat, and we need to sleep, and we need to get outside and get some sunshine occasionally, and those kinds of things.
But what about, um, just the mental health issue before we move on to the next things? When it comes to women's health around pregnancy, before pregnancy, during pregnancy, and after pregnancy, what are the things that we really want to have much more attunement about that we, we are getting better, but we've still got a way to go.
What do women really need us to remember when they're in those, those months of being pregnant and those early years of having small children around them?
Dr Vijay Roach: So I think you can divide it up into the women, the individuals themselves. Mm-hmm. Uh, women or, or women and families in that reproductive cohort, and then there's a sort of s- societal view around all of that.
And I think that the women who are in that, um, [00:50:00] group themselves, again, coming back to their capacity, is how much can they manage? 'Cause there's not gonna be sleep, and there's the physical demands of pregnancy and then birth and looking after young children. There's the moving out of the workforce and sense of identity, and all of those things that women can experience.
And so a recognition of that, and also remembering as well is the, that it's extraordinary joy as well. You know, that's a risk when you're talking about perinatal anxiety and depression. You say, "Oh, you know, you need to be careful because you might be unhappy," and all that sort of stuff. Actually, the most likely outcome is that you're gonna be overjoyed, and it's gonna be the most wonderful time of your life, and I think that that should be the starting point.
Not a pressure that it should be, 'cause if it's not, then that might be hard. But let's not detract from the fact that the vast majority of women are gonna be happy and healthy and enjoy that experience. Yeah. Then it comes to the cohort that they move with, and I think that that can be an interesting time because there can be competition, women policing other women, [00:51:00] expectations of motherhood, that you're, you're supposed to, you know, y- you the individual is supposed to be able to look after your child.
Your, your child's supposed to be healthy and well and happy and sleeping through the night. You're supposed to be able to breastfeed standing on your head. That, you know, all of those things become a competition, and that can be really problematic amongst women. How you birthed, which doctor you went and saw.
All of those things can, can become problematic, and so I think that, that group of women learning to walk together, you know, as colleagues rather than as competitors, I think is really important. And then I think, and I feel really strongly about this, and I incorporate this into pretty much any topic I talk about, and particularly this one, is that ultimately it's a feminist issue because women start behind right from the beginning, and they're policed, and they're judged, and [00:52:00] they're told the way that, you know, when they should be pregnant, how they should be pregnant, how they should birth, how they should look after young children, whether they should work or they shouldn't work, that they are born to be mothers and partners rather than individuals.
And, and society needs to keep on working on changing that attitude towards women so that we're respectful of them and their autonomy and their agency. So because I think that if you improve that attitude, and I mean, look, that's the Holy Grail, and it's gonna take millennia before we get there. But we need to keep talking about it.
Sharee Johnson: Not millennia.
Dr Vijay Roach: Yeah. Um, but, but if we, if we avoid saying it, and there is, you know, that, that things change over time and, and a word that was so celebrated is now one that's used with great caution. Mm. Uh, you know, I think that feminism is ... And as a obstetrician and gynecologist, it's highly relevant, but just as a human on the planet, as a, as a man, it's highly relevant to [00:53:00] recognize feminism and to be an ally.
And I think that that is really important if we wanna talk about the mental health, the wellbeing- Mm ... and the, the life experiences that, uh, women will have. And I think it's relevant to your audience because so many doctors, at least 50% and probably more than 50%, at least 90% of gynecologists, um, soon will be women.
And so the medical workforce is represented by women, but ... And will eventually they will become the dominant group. Mm. And so they need to explore these issues through that lens as well.
Sharee Johnson: It's not for us to talk about today, and I haven't done my homework in terms of the stats, but, we know that women, often are leaving medicine sooner than men.
And, and so, these are very important things for us to understand as well, that, you know, more women are coming into medicine, but then they're not staying as long. So what is that about, and how can we attend to that? It's a great shame for any doctor [00:54:00] to ... all the resources that they personally and the community puts into helping them get their education and be established and ha- they have the skills, the mastery that they have, to, to cut their career short because of structural or systemic problems.
So, um, yeah, I think there's a lot to talk about there another day, Vijay.. Let's go back to, uh, your own recalibrating. You learned all these things in your life about being a dad and what stress was on Cathy. Then you got involved in the Gidget Foundation, where you were for, I think you said 14 years before.
That was a really big commitment. And then you decided at some point, for whatever reason, to step out of Gidget. Gidget had its, had some momentum and some, some longevity now. And so what was that recalibration? What did you do? What did you decide you would do instead, or what opportunities were happening then?
Dr Vijay Roach: Well, I think that actually coincided with my opportunities with the college. And so there are 15 medical colleges. Each of them has a structure, a council, a board, and, and a [00:55:00] president. I had actually been doing college work for 20 years at that stage, which also links all the way back to the beginning of the conversation, which is that if you eventually wanna progress through any kind of system then it's not something that happens in a year or two or five. It's something that takes a long time, and a lot of commitment, and a lot of hours. And I had done those, not, not, again, not through sort of any sense of altruism, but just because I was enjoying it and I liked being part of that community.
Mm. And eventually I was a member of the board, and then the board, uh, elects a president, and I became the president of the college. And that was an extraordinary opportunity. I thought it was gonna be three years of sort of swanning around the world in my robes and, uh- ... having fun, but after one year of doing an enormous amount of travel and having the opportunity to give speeches and meet people and do all sorts of things, COVID arrived.
And so I spent the next two years online.
Sharee Johnson: Like this.
Dr Vijay Roach: [00:56:00] Yeah. Look, it was really, really hard. I used to, on top of my clinical work, which we, we still did during COVID, but on top of my clinical work, I reckon I was doing about 30 hours of college work a week. And I was doing things like writing all of the statements that came out from the College on pregnancy, managing the workforce.
We were discussing things like surgical lists and, and canceling elective surgery. There was interaction with the government. Sometimes I got that right, sometimes I got that terribly wrong. It was a time when nobody knew what the answers were. We were all fearful that it was gonna go terribly, terribly wrong.
It's interesting reading about and watching television shows on the way that COVID was handled medically in other countries, and Australia handled it brilliantly. Mm. And really, we did not have numerous deaths because of the way that it was managed, and a lot of that was [00:57:00] due to the College leadership.
Sharee Johnson: Mm. I, I've had the honor of coaching a number of college presidents, um, over the years, which has been extraordinary learning for me in terms of the politics and the governance that goes on. And it's a very interesting role to be a president of a college in terms of, you know, you're representing the members, and so this issue of, you know, you know, what does the president of a college do?
And what if the members are divided or the members, change their mind in some way, some issue comes up politically that wasn't known when you stood to be president, but now it is coming up and you're the president. Can you offer some reflections for, you know, perhaps we've got some presidents listening, perhaps we've got some aspiring presidents listening, or perhaps we have people who are involved in their own, leadership in their organization.
What, what comes up for you when you think about that role of president of something that is interacting with the members and the government and,
Dr Vijay Roach: There's a American, I think he [00:58:00] was a psychologist, called Robert Greenleaf, and he wrote about the concept of servant leadership. When I read about that, I found that really appealing.
And, and if we go back, you'd asked me why I decided to do medicine. You know, my concept had been that my life was one that I wanted to be of service. Mm. And so then through that service eventually came leadership opportunities, and then you become a leader. And I think that there are different types of leaders.
There are some who just want to be the leader, and that's important to them, and that's how they arrive in that position. But I think if you arrive through the servant leadership role, then everything that you do and the way that you interact with the people who you're serving- has that purpose. And so with the college, I felt really strongly that the members, myself, I actually saw myself as a member of staff, and we were there to serve the membership.
Mm. And so I used to go to all the staff meetings. And, uh, and, and, and I had a very close relationship with the college [00:59:00] staff, and I valued that very strongly. I had an excellent CEO, and together we always presented together that we were looking after the membership. And of course, we had the other roles, the advocacy roles, and the other important leadership external sort of roles as well.
And then the other thing I think, which is drawing from that relational aspect of the way I like to interact, was a membership gives you an opportunity to be relational. Now, if you've got 8,000 members, you're obviously not gonna get to know 8,000 members. But you can get to know a lot. Mm.
And you can go and talk to people at meetings, or you can do online forums and you can talk to people, or you can reply to emails directly, or you can pick up the phone and ring someone if they have a grievance. Uh, and that's what I did, you know, is that any opportunity there was to interact with a member, th- then I took that opportunity.
And so you connected with that sometimes individual, sometimes group. [01:00:00] And I found that very valuable. One of, one part of it was connecting with the group of people who were non-white Anglo-Saxon, people who had not been born in Australia, people who didn't have all of the connections and privileges of being born in Australia.
Uh, and I could in some way represent where they came from, and they could see someone who looked like them. Maybe didn't sound like them, because I have an Australian accent 'cause I was born and brought up here. But that they didn't in a sense feel alone, and that they , they could see themselves as part of the college rather than sitting aside from that.
Sharee Johnson: What about the media, Vijay? Did you have any training to do... You know, yous talking about writing all of the statements and so on. Was, who was helping you with that? Might not have been in your case a brand new thing. But I think for some people that reach these positions, it is a brand new thing to start, um, advocating at government level and to the media and, the voice of the college to the, to the public.
Dr Vijay Roach: So [01:01:00] I think that there was a lot of, um, skills that I developed through doing public speaking from a very early age, and so I did it really from when I was in primary school, and it was something that I was confident about and something that I was able to do and something I knew how to present myself and how to give the speech that was required.
And I took that confidence into media appearance on television and radio, and I think it's not unreasonable to say that that generally went well, and I think part of it was just by doing so much. Mm-hmm. So there's that sort of Malcolm- Right ... Gladwell 10,000-hour concept, and I do think that a lot of the success that I have is not because I have some inherent skill, but because I just did so much.
Mm. And so therefore, I became confident about that. Now, you don't wanna have too much hubris with that because there are also times when on occasions I stuffed it completely, and I do think that one skill that I didn't learn [01:02:00] was the interaction with, um, politicians at a minister sort of level. Mm. With the public servants, really good relationships and good conversations.
But with the ministers, I never really connected successfully, and I don't know what that was. I think that, part of it could have been that I didn't understand the language that they were talking about. The other is that these are really busy people, and I'm just some small cog in the whole thing, and so maybe there wasn't a particular interest in what I had to say.
Occasionally, and there was a couple of times in COVID where I overstepped my role and made some mistakes without realizing that these people were managing much bigger picture, and that was an error on my part. Um- So I think that m- training in that might have been better. I could have done that better, and I think that if I'd been managed by someone, that would've been good.[01:03:00]
And the other thing that I had, which I was really lucky with in that time that I was president, was a quirky media manager. Um, and he and I just got on brilliantly. He was insightful. He was an extraordinarily right-wing individual in... And, and again, this is where humor works, is that was our, our source of, um, humor together, you know, which was where I was the leftie and he was the right-wing person and, and, um, I'd, I'd constantly say to him, "I'm gonna turn you into a left-wing person by the time I've finished with you."
But he would look for media opportunities. He'd give me advice. When we were writing all the COVID statements that had to go out rapidly, he would always be responsive in doing that. Um, and so I think that media is something that is very complex and it requires a degree of confidence, and that was something that I had because I had done it for so long.
Sharee Johnson: I wonder if we can bring imposter [01:04:00] syndrome in here and talk about that a little bit in terms of, um, doctors have many, many years to train technically to be their specialty, whatever it is, and, uh, often none in leadership or media training or um, you know, , they arrive at the seat, sometimes they get into the seat at the table of power and they literally don't have the skills that they need to support themselves or protect themselves or to make their case, and that can be harmful to the issue or, the fight that went on to get a clinician at the table in the first place.
It also can be harmful to the individual. It can be really undermining or confidence dinting. I, I wonder, what your thoughts are about how we help doctors really understand that that's a different set of skills, leadership and business management and so on, and how to help the system collectively help the doctors get those skills, have those skills that they need.
Dr Vijay Roach: I wonder, my answer's actually counterintuitive, which [01:05:00] is I, I also wonder whether we should be, and it does fit with Recalibrate, is whether we should also be identifying the people who don't have those skills. Mm. And maybe in a sense won't develop them, and not make an assumption that everybody who...
And I, I wanna take it all the way back, that everybody... You know when you, you have children, you say, "You can be whatever you wanna be." Well, I couldn't have been an athlete no matter how hard I tried, so, you know, there, there's no point in saying, "You can be who or what you wanna be," because everyone dreams of playing, you know, cricket for their country.
But- In the same way, you know, I would like to be a doctor. What we see with medical students and then once they specialize is there are some people who really, this is not the profession for you.
Sharee Johnson: It's not a good fit.
Dr Vijay Roach: It's not a good fit, and what it's gonna do is make you miserable and not necessarily the best doctor that a person requires, and that outcome's not gonna be good [01:06:00] for anybody.
Mm. And I think similarly, we see people who end up going down leadership pathways, and it requires something about you. And we tend to talk about that in positive ways, and so therefore there is an aspiration to be a leader because leaders are liked or they're powerful or they're popular or whatever it might be.
But actually, even though that would be a nice to have, it might not be what your set of skills are. And I think when you talk to people who have had leadership positions and you would've... You know, the presidents that you talk to or the other leaders in other positions, while when we look at them from a distance, we think that they're sitting there thinking how amazing they are.
Actually, you don't. Actually, you, you just do the job. You turn up, you do the job, you have a certain set of skills. You know how to give a speech, you know how to impact people emotionally or to, to influence them in some way, [01:07:00] but it doesn't mean that you have tickets on yourself. It actually means that you're playing that role for that purpose.
So can you teach people? So interestingly, last night I was with a family member in casualty, and I had the opportunity to observe what goes on in that setting, and it was interesting to observe the different ways that different people interacted. I didn't reveal that I was an obstetrician in the hospital, in my own hospital, because I didn't want to influence the care of my family member, and that's interesting in itself, that I was nervous that if I came across it and said, "I'm a consultant here," that people would get irritated and that my family member would not have got the care that I was hoping they would get.
But what was interesting, I kept on thinking about the way that they spoke to us. I kept on thinking about how there was an [01:08:00] efficiency and there was a introducing themselves. We even noticed the fact that people used their names, which is a big difference to what used to happen. Mm. That was positive. But there was no warmth at any point in time, not once.
And this family member was quite unwell. They were feeling pretty miserable, and they looked pretty miserable, and no one said, "Are you okay? Sorry you're not feeling well. Would you like a glass of water?" Nothing. They did all the examinations. They explained everything very well. The care that we received was excellent.
But at no point in time was there a human touch. And w- coming back to that can you teach someone leadership, I think that there is a huge opportunity in medicine to teach people skills, which could include leadership skills, but even how do you say hello properly? How do you make someone, even if you don't feel it, how do you make them feel like they matter?
Because in that situation, the [01:09:00] patient's the vulnerable one. They didn't ask to be there. They're not being demanding of you. They require the care that you are trained to give them. So, how can you make that experience better, even if it isn't deep in your heart? We're not asking you to be everybody's best friend.
And the analogy that I've always used is that, and I use Qantas quite specifically, because you sit there... When I did all of those flights with the college, I used to deliberately fly economy because I was not gonna waste the, um, college's money. I'd sit there in my little economy seat, and I would remember when the flight attendant would hand you your cup of coffee, and for one brief moment he'd catch your eye, give a smile, and then you know he's going to serve another 100 people, and he doesn't remember you, nothing.
But for that moment, he made me feel valued. Mm. And I think that if we could teach [01:10:00] doctors how to do that, then... And we could teach them those skills by having the Qantas flight attendant come and talk to the medical students, then I think that we could improve that culture of medicine. And similarly, if we looked at leadership outside of medicine, and leadership skills that are used in other arenas, and applied that to the group of doctors who are gonna end up in that role, and also recognizing that leadership is something that a doctor does every day anyway, then I think that that would be the place to get our learnings from.
Not think that because I'm a doctor, I can do, you know, every sort of skill. I have every sort of skill, or I could do every sort of role.
Sharee Johnson: Mm. I think part of the challenge is even when people are taught empathy falls off in third year of medicine school. Mm. So people arrive with empathy, with intention. They want to be of service. They want to care. They want to help, in general. There are exceptions to every rule. [01:11:00] And by third year, just when they're starting to get ready to go into, into clinic, into rotations, uh, their empathy is already on the decline. And so I, I think, you know, we bring these open-hearted people in, and we get them acculturated pretty quickly to how they have to behave. And, and when people are in survival mode, which not all healthcare workers are, but many are, and especially in tertiary places where there's not enough resources for the, the demand, for the growing population, and the older chronic diseased population, um, we forget those very basic things like smiling.
Mm. There's a, there's a very old study that was done at Princeton in about 1978, .. it's known as the Good Samaritan, um, study. And they asked people who were studying theology, so you might assume that they were kind, caring people, um, to cross the campus to get to another site in time. And they told some people, "You really must hurry because you're going to be late.
You've really got to really hurry, hurry, hurry." And they told other people, you know, "Just make your way across the [01:12:00] campus and, uh, you know, things will be good when you get there." And they put somebody in the way that they passed who was in distress on the ground. And hardly anybody in the hurry condition stopped.
The biggest, impact on the people's compassion was the idea that they were in a hurry. And you and I both know that the health system is full of people- Mm ... who feel under pressure- Constantly ... and in a hurry. And so it, it really damages our capacity for compassion, and it helps us forget to smile. But it is a cultural norm as well.
And so if the cultural norm is challenging that, enough people are challenging that, I think we can turn that round pretty quickly. A- a- at the risk of talking for too long there's also a campaign that came out of, uh, uh, England, out of the NHS. I can't think of the lady's name right now. You probably know of it.
She had cancer herself. She was a healthcare professional, and she has since passed. But she promoted s- stickers that said, "Hi, my name is Vijay." And this [01:13:00] very small thing of introducing yourself and when you walk into the room, it's a very human thing. You're gonna ask me personal questions, and I don't even know what your name is.
Dr Vijay Roach: Yeah, absolutely. Or, or maybe sometimes what your role is as well. Mm. And so therefore, how much should I reveal, or how should I respond to you or interact with you? And I'm feeling vulnerable and lost.
Sharee Johnson: And tired and sick.
Dr Vijay Roach: But I think the other way, or the ... And, and for your audience as well, the other message is it's actually incredibly rewarding for yourself.
Yes. You know, when, when you go into work, I have this thing that, you know, when I'm walking along the corridor, I smile at everybody. And I'm sure people think, "Who was that weirdo who I just went past?" But I smile, and they smile back, and everybody feels better.
Sharee Johnson: Yes. It's contagious.
Dr Vijay Roach: It suddenly makes my day a better day. Yeah. So there's all a reward that comes to you. And look, in the end, you gotta go to work. You gotta [01:14:00] do your job. You might as well make it a more enjoyable environment. Mm. There's no loss in doing that.
Sharee Johnson: No, that's right.
Dr Vijay Roach: And so even if you just do it because you want to enjoy the day better.
Sharee Johnson: Mm-hmm. I think this is a mini recalibration, actually.
If you can remember in the course of the day or if you can think to yourself, "I don't know if I've smiled at anybody today. I'm gonna smile at the next person I meet," then that's a, that's a sympathetic, parasympathetic nervous system reset right there. Um, you know, you can actually walk around with a pen sideways in your mouth, which makes your mouth smile, and tells your brain that you're smiling even if you're not smiling.
Yeah, of course. And there are res- resilience organizations that teach that, that as a little hack to help your mind kind of reset and get into a different space.
Before we finish, Vijay, uh, uh, can you say some more things about imposter syndrome specifically? I had the, the great opportunity of running some workshops for RANZCOG for about three years during those COVID years.
And, um, I was always surprised. There would be, like, up to 20 people come in on, in the [01:15:00] little boxes on the screen, and there would usually be one or two very senior people consultants, and one or two registrars and, and then a group of consultants in the middle. And, uh, the great gift that the very senior people gave nearly every time was telling a story at some point during the three or four hours about their experience with imposter syndrome, and the young doctors being very surprised about that, that, you know, "What do you mean you're having imposter syndrome?
Like, I thought when I got to be a consultant, I'd kind of get over that, or I wouldn't have that anymore." Can you just share a little bit about your experience of imposter syndrome?
Dr Vijay Roach: Well, I think that it, it, it isn't something that's present in sort of in every consultation. I know that I'm a competent doctor.
I don't think that I'm a brilliant doctor. But I don't think that I'm not a competent doctor. And I'm quite satisfied- being a competent doctor. And I would actually counsel doctors and I would counsel patients against seeking, you know that, that classic question, "Who's the best orthopedic surgeon that you know?"
And I think, I don't know. You [01:16:00] know, all I look for is somebody who is well-trained, good, competent, and their manner is one that is kind and, and, uh, caring. And so I think what you question, because I think medicine's so challenging, because the stakes are so high, because you're interacting with another person and you're interpreting their perception of you, and you can get that completely wrong, is you then...
ease, it's very easy for self-doubt to creep in. And you will make mistakes, or there could have been a different way of doing that. And when someone, someone else suggests, "Well, I would have done it that way," then you second-guess the way that you're doing that. When you're doing things like surgery, that's very challenging, and you know that complications can occur, and you wonder whether the outcome would have been different if another doctor had done that operation.
And you need to keep on reminding yourself that no, actually, that complication would have occurred in their hands as well. And so you do [01:17:00] your job. You need to be well-trained. You need to be diligent. You need to be careful. You need to check your results. You need to go and see your patients. You can't not do those things.
But if you are doing those things, then you will still have doubt in your mind, and you will still have errors, and things will happen because they happen. And you will also worry about the way that people perceive you. I think that those things are normal, and they don't leave you. You just learn different ways of masking them and managing them.
And I think what you were talking about, that importance of sharing our experiences, particularly when we get to senior positions. I do, I worry. I, I think about the things that I do. I wonder whether I've done them, uh, to the standard that was required. I wonder what the outcome's going to be. And imposter syndrome, I suppose, it, it could be variously defined, [01:18:00] but it can be potentially a, a debilitating condition.
But I think a healthy degree of humility and concern that I ... Or, ... I think you can morph it into not having to be the most important person in the room, not having to be the cleverest person in the room. Yeah. But not seeing that as a weakness or a failure, but being comfortable that you're a competent person.
Sharee Johnson: Mm. I think, um, you're, you're really pointing to, to this idea that imposter phenomenon is really about, "I think I'm a fraud and they're gonna find me out that I'm a fraud." And you're really talking about, uh ... And some of that comes with perfectionism. You know, if people who are really kind of bound up and spending a lot of energy on whether they're perfect and how can they be perfect, and the external achievement measures that need to be present all of the time.
, The ... It's a very exhausting way to live, it takes a lot of energy.
Dr Vijay Roach: Absolutely.
Sharee Johnson: And, and you're really pointing to this concept of good [01:19:00] enough or, or more than good enough, but, you know, am I capable and competent? Do I have the right checks and balances in? ... Do I have people around me that I can, talk through the challenges that are inherently in my work?
And that's all that anybody can, who's recognizing their humanity can provide.
Dr Vijay Roach: Yeah. It's the best that you can do, and also it's the recognition that sometimes perfection isn't achievable in the sense that you're dealing with a human body, you're dealing with variations. Mm. There's things that are actually beyond anybody's control, that there will be a statistical rate of things not going the way that you want to.
That actually there can be various outcomes, and they can all be interpreted in different ways. There was the Irish doctor who was in the, with the WHO during COVID who became very famous for that clip of talking about, you know, perfection being the enemy of the good. And so therefore you can paralyze yourself with imposter syndrome as well, and that isn't helpful.
But maybe coming back to the way that you asked that question, and [01:20:00] in terms of talking to people who are junior to me, and now that you get old, everybody's junior to you. You know, when people come in and they say, and they're a patient, and they go, "I was your medical student once." And you go, "I don't find that, you know, warm and fuzzy, thank you very much."
You know, that is just telling you that I'm old. But what do you wanna communicate to them, to the medical students? What do I wanna communicate to my children? You know, there's that thing about- what will be the greatest way that you could love the next generation is to hope that they will be better than you are.
Mm. You know, that their lives will be happier, that they will have more opportunities, that they will believe. That in my situation with my five children, with, with all the students that I've had, with the junior registrars, nothing's more fantastic than telling a junior consultant how amazing you think they are.
Mm. Because they think that you are the consultant. You'll always be the consultant in their eyes, and [01:21:00] it's the same with your children, is to say, "You know what? You five are incredible." Mm. "And you five, uh, will take my role as, you know, the sort of leader of the family or the elders of the family. And, and you have all the resources within you, that it isn't all held within me."
And I think that that's not imposter syndrome, that's humility, but it's also a joy when you have that opportunity to grow people. And I think if we share with our children, if we share with, uh, our students and those who are junior to us the times when we found it really difficult, the times when we were challenged, the times when we made mistakes, the times
We even have one thing in our medical school where there's a few of us that get up, and again, with some courage, talk about times when possibly our management was unethical. Wow. And that's a very brave thing to do. Very. To stand up in front of an audience and say that that [01:22:00] happened because of this moment or those circumstances.
I think if we share those things and those vulnerabilities, then that can be very empowering for-
Sharee Johnson: Absolutely. So normalizing. So, again, shattering the myth of, the superpower, superhuman doctor with his cape on that's not really like me and never gets sick, you know? Mm. Fantastic.
So the last kind of, I guess, topic, Vijay. You're in the latter part of your career. I don't want to suggest that you're about to retire or anything like that, what do you feel like you've learnt about recalibration you know, the necessary part of life that we're recalibrating all the time?
What's, what's that like at this part of your career when you are thinking about, I wonder what's after medicine, or I wonder when ... will there be a close to medicine, or am I gonna go on till I'm 85? Or, you know, what, what's, what's ... What are the things that you notice about recalibrating this part of your career?
Dr Vijay Roach: Well, I've been thinking a lot about the fact that a lot of the time I think I would've denied if somebody said, "What was your identity caught [01:23:00] up with?" And I think actually being a doctor is being a doctor, and being a doctor is really important to me. It's something that I value, the title, the position,
Just the, the, the sort of recognition of being a doctor. And so I think that that's gonna be quite hard to give up. Mm-hmm. And, uh, also for me, being a doctor, I think I narrowed it a lot because I only saw being a clinician as being a doctor, and I think that's a mistake. Because I think I'm a doctor and I have been primarily a clinician, but my doctor docterness has come out in the leadership roles, in the way that I interact in other areas as well.
So I still remain a doctor even if it isn't patient-facing. So I think I am gonna be able to retain that looking forward. And then the other thing that happened is, you know, when you're tired and you're busy and you're fed up and you've lo- got compassion fatigue and you don't wanna do it anymore, you have a list of all the [01:24:00] things that you don't want to do.
Mm. So I just had two months off, and that's another important thing, is that if you have enough time... Because if you try to work it out over dinner or on a weekend, it's not gonna happen. Yeah. So by having a length of time to pause and think and reflect, I then thought, "Why don't I write a list of all the other things that would interest me, that I'd like to do, that I would enjoy?"
And some... Not a bucket list, but just the things that I think, "Hey, I'd quite like to explore that and I haven't had the opportunity to do that, and what would, what would I do?" And so when you have that list, then you start to realize that, okay, I can't do all of it, back to the capacity thing, and so therefore, what will I be willing to reduce or, um, do differently in order to be able to do that?
And, and I do think I'm arriving at a point, I don't think I'm there yet, I think that I'm getting close to realizing that at some point in time, whether it's now or in five years or however many years, [01:25:00] that being a clinician, and that's w- the imposter syndrome, the, the worry that, you know, an error might occur or there might be something...
You don't want to go out in a negative way. Mm. So I think that I can see that reducing. But I don't think that all these skills... Doctors just think that they know how to diagnose and treat. But actually you've learned all of this- massive range of skills by being a doctor, and I'd like to apply them in other areas.
So I'm interested in doing board work. I'd still always want to do not-for-profit charity type work. Um, I think I'd also like to explore the things that are fun. I'd like to bit of exercise. I'd like to get out and do more things.
Sharee Johnson: I think you said to me, "Go to the movies," which all those years of being an obstetrician you couldn't do.
Dr Vijay Roach: You couldn't do because you're always on call. And but to go to the movies because you're mindful while you're in the movie, that you're immersed in it and that you enjoy it. Yeah. And, um, to have [01:26:00] that experience, ... I'd like to be more mindful in other areas of my life. I'm looking forward to that.
And that will be also spending time with friends and family and children and grandchildren and, and Cathy, my wife, to enjoy them, uh, rather than fit them in.
Sharee Johnson: Mm. Yeah, be really present to them. Mm. As always, I've just enjoyed our conversation so much, Vijay. There's lots of examples of recalibrating. Is there a mantra, is there one or two things that you,
hang on to when things are a bit crazy and you know you've gotta recalibrate but you don't know what you need to do yet? Is there a way that you steady yourself when that's happening?
Dr Vijay Roach: I think one of the things I ... And I was talking to a patient about this the other day, is that if you're having that moment of anxiety, and that's another thing.
You know, we talked about all of these different things that people experience but nobody ever admits to. And the leader, you know, the big obstetrician, the person who can um, turn up when someone's bleeding to death and [01:27:00] sort that out, the thought that you might actually worry about stuff- Mm you know, that couldn't possibly be. Mm. And the thing I think, and you would know this better than me as a psychologist, but, you know, anxiety is irrational. Anxiety is all the stuff that makes absolutely no sense. And so I have my things that I worry about and that I'm anxious about. But what I do is that I think, "Okay, I've got this feeling," and I'm worrying and I'm worrying and I'm worrying. And I remember I've had this feeling before, but I actually can't even remember what was happening when I had this feeling before.
But now I know that I must have survived. Mm. So therefore, it must be possible to get through this feeling, and it might not be an enjoyable journey, but it will actually work out in the end. Mm. And I think similarly, when I've had points in my career where I'm not enjoying it or where I want to do something, that has happened before and somehow or other I've worked out what to do.
But I think [01:28:00] my message, and I think it's almost really the theme or my interpretation of what I get out of my conversations with you and the work that you do, is actually even to start to ask the question. Because in the era that I became a doctor and in the era before, you didn't ask that question. The day you became a doctor, that's what you're gonna do for the rest of your life, and there is no getting off that.
Mm. Now I think it's okay to question the things that you do, the way that you do them, whether it actually is the right career for you, whether you wanna practice that many hours or in that setting, or whether there is, in fact, different things that you want to do. And I think that- It's really important to give yourself permission to explore that.
And you won't be a failure if you decide that a different pathway is okay for you. And I say all of those things while I'm now really thinking about that, [01:29:00] is that if I decide that I am going to be, have a, a different end to my career... Even when I decided to stop obstetrics, that was a big call. Mm. I was a popular obstetrician.
I had a full practice. I could've kept on doing that. And I made that call for all sorts of different reasons, the main one being that I wanted to be present and I wanted, uh, to not be on call all the time. And it was okay, and it has been okay. And whatever the decision is that I'm gonna make doing something that is, is not being that clinician anymore, it'll be okay.
Sharee Johnson: . Let's leave it there. That's a lovely place to finish. It'll be okay. Mm. I hope that all of the listeners, not just the doctors, but all of our listeners can have a sense of that. In this last bit, it's really been a sense of make a little bit of space. Just make a little bit of space to notice what you're feeling, what you're thinking, what you need.
Mm. And to give yourself permission for that, [01:30:00] and, and to say, "It'll probably be okay. I've had these feelings before, and I'm still here." So- Mm ... uh, it's a kind of a back yourself message but, but one with a bit of humility, and you've used that word a number of times, Vijay, and I think that's might be, one of the kind of really salient pieces of wisdom that you've offered us today.
So thank you very much for your time.
Dr Vijay Roach: Thank you, Sharee
[01:31:00]
