Recording Podcast (Jillann Farmer) with Sharee Johnson
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[00:00:00]
Sharee Johnson: It's quite a challenge to give you a summary, a little precis of what this conversation includes with Jillann. She draws the contrast between her medical life, her medical world, and the wider world a number of times in the conversation, talking about her experiences, um, as a student representative at university, not just for medical students, but for all of the faculty.
Sharee Johnson: She draws the contrast between working, uh, for the UN based in New York in the wider world with a wider world lens, perspective than when we might just be working in our own home country. And she has a very healthy respect for, learning beyond medicine. She's about to do the Australian Institute of Company Directors course. She's choosing the mainstream, route rather than the health-specific route because, her past experience has taught her that she'll have a wider learning experience and, learn new things if she can step outside of what she already knows. Jillann, uh, maybe wasn't a systems thinker at the beginning, but she [00:01:00] certainly is now.
Sharee Johnson: She has that, depth of wisdom and experience that I think people get when they've been testing their ideas for a long time, to be able to step into that very human, one-on-one, face-to-face, uh, experience, and then to step back out onto the, that sort of big global thinking. I, I think she's a terrific role model for all of us in noticing where our perspective is and in noticing that we might take a different perspective, that there are other perspectives worth being curious about.
Sharee Johnson: We talked quite a lot about the culture of perfection that exists in medicine. Uh, Jillann reminded us that perfection can be very good when it encourages striving. It can also be bad when it discourages us from stepping up. We talked about opportunity and how to see opportunity and to step up and do things differently or outside of what we might have naturally expected and the benefits that that can bring.
Sharee Johnson: And we talked about intersectional disadvantage. Uh, this particularly could have been, uh, the whole podcast. [00:02:00] Jillann has some very, useful insights, I think, into understanding intersectional disadvantage and privilege, and she in particular pointed to, this concerning idea that people say they're colorblind.
Sharee Johnson: Jillann reminds us that being colorblind is not a kindness, and she describes it as this is a stubborn denial of intersectional disadvantage, and that those with privilege need to be working to help remove the barriers that some people, um, experience and others do not experience. I hope you enjoy this conversation.
Sharee Johnson: I want to just let you get on to hearing, uh, Jillann, and I look forward to your feedback as you, soak up the wisdom and the experience of an Australian doctor with a very global, experience and perspective
[00:03:00]
Sharee Johnson: Dr. Farmer was the medical director of the United Nations at the headquarters in New York for eight years. During her tenure at the UN, she was responsible for the health, safety, and wellbeing of all of the UN personnel deployed throughout the world, and she was also responsible for the standards in healthcare facilities that were operating under the UN flag.
Sharee Johnson: Dr. Farmer managed the UN's response to the New York wave of COVID-19 in twenty-twenty. Since leaving the UN, she has worked as a deputy director general in Queensland Health and as a frontline GP in primary care and [00:04:00] a rural generalist in emergency medicine. Prior to serving in the UN, she was the medical director of the Patient Safety Center in Queensland Health and the inaugural director of the Clinician Performance Support Service.
Sharee Johnson: From 2023, Jillann has been the Chief Executive Officer of A Better Culture, a project to shift the culture of medical practice to one of respect, inclusion, and equity. She is currently a member of the board of the Australian College of Rural and Remote Medicine, known as ACRRM to many of us.
Sharee Johnson: Outside of work, Jillann has been a martial arts practitioner for thirty years and is a keen hiker, kayaker, cyclist, and cross-country skier. In fact, the first time I had the privilege to be on the stage with Jillann, she arrived at that event in a different state to where her home is with her fold-up bike that she had brought on the plane with her so she could get around when she got there.
Sharee Johnson: It's my absolute privilege to [00:05:00] introduce to you Dr. Jillann Farmer and to talk with her about a wide-ranging, deep, , ranging set of ideas. Jillann, thank you for coming here today. uh, after all of that bio, you have some idea, Jillann has so much breadth and depth in medicine in Australia and in the world.- We're so lucky to have her here. Welcome Dr. Jillann Farmer to Recalibrating with Sharee Johnson.
Dr Jillann Farmer: Thanks, Sharee. It's a pleasure to be here
Sharee Johnson: it's really lovely to see you. I haven't seen you for a couple of years and, and a lot has, is always going on, isn't it?
Dr Jillann Farmer: It, yeah, it certainly is. And whilst, um, the big project I was working on, A Better Culture, sort of dropped from very high profile public view, the work continues, and I'll be happy to talk about that if it's something that we walk across.
Sharee Johnson: Yes, I'm very much looking forward to doing that. But before we go there, you work as a rural generalist in- Mm-hmm ... emergency medicine in Queensland. It doesn't really capture all the things that you're interested in. Can you tell us a little bit about, you know, what your work looks like, say, say an [00:06:00] average month at the moment in 2026 for Dr. Farmer?
Dr Jillann Farmer: Yep. At the moment I'm- i'm sort of anchored in clinical work, and the reason that I'm doing that and, uh, you know, it is something that I feel very privileged to do is because it actually just gives me profound joy. I love clinical work. It's something that I have always loved, and even when I stepped out of clinical work to, into medical administration or system leadership roles, I used to find that I really missed patient contact.
Dr Jillann Farmer: And I, I was of the view that we need people in healthcare leadership who miss patient contact, for whom, you know, the beating heart, you know, the reason of why they're there is to try and make things better for the people who need healthcare services. So it has been a really joyful experience to return to that.
Dr Jillann Farmer: Um, and I, I started off working in, um, metro general practice. But as had happened to me previously in GP roles, I found the challenge of [00:07:00] delivering, you know, true continuity of care and being there consistently for patients was a bit too hard with all of the other commitments that I have. You asked about a typical month.
Dr Jillann Farmer: So, um, I am working in a, a emergency department in an MM3 area (Modified Monash Model - town with 15,000- 50,000 people), so it's not super rural. But I'm also doing, , a lot of conferences at the moment and I'm also trying to help grow the next generation of conference speakers, so sometimes supporting behind the scenes. Um, I do a little bit of mentoring.
Dr Jillann Farmer: I've just set up my own, um, consulting business which I describe as more of a hobby with an ABN at the moment than, you know, a truly going concern. But I realized a lot of people were asking me to do things, and I didn't have a vehicle through which I could convert that to something that justified the amount of time required.
Dr Jillann Farmer: I'm doing a bit more work on A Better Culture, which is very exciting. Um, the, the Commonwealth funding for that project ran out on the, in the, on the 30th of June last year. But the College of Medical Administrators who had hosted the program, um, really didn't want the work to just die [00:08:00] on the vine, and so they have, um, maintained- A trickle of funding to allow me to develop a few projects within that.
Dr Jillann Farmer: And we're hopeful that, um, very soon we'll have some very concrete, um, products that we'll be able to put out. I can't forecast at the moment, 'cause some of them are still subject to fairly sensitive discussions with partners. But A Better Culture is not dead. I've been describing it as on life support.
Dr Jillann Farmer: Mm. Soon to be breathing on its own again, we hope.
Sharee Johnson: Coming out of ICU back onto the ward. Fantastic.
Dr Jillann Farmer: Yeah. Exactly.
Sharee Johnson: Before you were involved in these kind of big organizational viewing projects and, and, you know, Better Culture, you were managing lots of volunteer health people from- Mm ... all the, the system.
Sharee Johnson: It really was a huge project. But as we heard in the bio, you know, you looked after New York during COVID in, in 2020, in that first wave. I mean, my mind's kind of boggling a bit about how you keep across the fast pace of something like that. Can you share a little bit of that experience of being in the UN in [00:09:00] 2020 and managing- Yeah.
Sharee Johnson: Um- ... COVID response?
Dr Jillann Farmer: So I guess that was the capstone of my UN work and, and, um, that was done in, uh, an environment where I had, um, deep and wide networks. So I had a whole lot of people I could call on, and I already had the trust of the people who needed to trust me. And that's where I think I had an advantage over some of the public health colleagues who were walking, working with the broader population in the US.
Dr Jillann Farmer: One of the things that I realized quite quickly after I moved to New York, I moved to New York in 2012, just a few weeks before Hurricane Sandy. And the hurricane notices were coming out, and they were telling us that it was gonna be terrible. And I was really shocked by the amount of, of cynicism and disbelief in the population.
Dr Jillann Farmer: People didn't believe their government when they said that there was an emergency coming. And, um, I was so accustomed to Australia where, where our [00:10:00] government puts out an emergency notice, we believe them and we act on it. Um, and so I was working in an environment in COVID where trust had been built over a series of, you know, increasingly challenging events.
Dr Jillann Farmer: The biggest one had been the West African Ebola outbreak and the work that I had done there. But in COVID in New York, um, the situation evolved very, very rapidly. New York became the epicenter. I remember for several weeks watching my colleagues in Rome because Rome had started off as one of the big- biggest capital cities to be affected.
Dr Jillann Farmer: And I was, um, also, you know, regularly in contact with Chinese colleagues and members of the diplomatic community in, um, from China in New York. And, um, you know, exercising what solidarity with them I could as their family members were affected, and then suddenly it hit us in New York. And, um, one of my colleagues at that time was, um, Penny Abeywardena.
Dr Jillann Farmer: She was the New York City Commissioner for International Affairs. And she's got a book coming out [00:11:00] shortly, um, in which she describes our first conversation when we knew how bad it was. Um, and for me, that moment was when the first confirmed cases were reported in the UN International School. The UN had a school for all of the expats. And we knew by then that it had an, you know, a- an unprecedented level of, you know, for anything that we had dealt with, ability to spread.
Dr Jillann Farmer: And we had a confirmed case in UNIS, the UN school. And so I rang the New York City commissioner and notified her, um, that that had happened, and that we could expect a, you know, v- very rapid escalation and spread, and that is exactly what happened. I don't think I was the first signal she received that this was going on, but it was one of the very early signals.
Dr Jillann Farmer: And, um, and then the next thing was when the public health authorities in New York City stopped contact tracing. The- they were utterly, utterly overwhelmed in terms of their ability to contact trace and try and [00:12:00] contain. And then it became just mitigate. And I had to, um, help the UN to make some, you know, several really key decisions.
Dr Jillann Farmer: Um, as the medical director, there were some things that I was responsible for making an absolute decision for, but there were some things where I was an advisor to senior decision-makers. And the first really critical decision, and I remember it so clearly because it was the first time I had felt, in that context, the weight of my advice and my decisions, was the, um, the cancellation of the, um, the face-to-face meetings of the Commission on the Status of Women, which was due to meet in New York.
Dr Jillann Farmer: And we went through a whole pile of risk assessment and, you know, looking at where delegates would be coming from, how they would be mingling, what the civil society representatives there would be. There was going to be a very large proportion of people who were vulnerable because of the nature of that work of representation from civil society.
Dr Jillann Farmer: And I remember sitting in a room with the Chef de Cabinet, who is the secretary general's, basically, chief operations officer, and [00:13:00] giving her all of this advice and, and then she just said, "Well, that's it. I'm making the decision. We have to cancel CSW." And that was my, sort of, my heart just, I almost felt like it snapped in two 'cause it was such an important meeting that so many people had been working towards.
Dr Jillann Farmer: But the potential harm was just gonna be beyond belief if we had allowed that to go on. And then bit by bit, the, the gravity of that situation increased until, um, I gave the advice to the Secretary General that we needed to close the UN headquarters. And that was something that I was trying to manage in lockstep with the city of New York, because by that stage already, even at that very early stage, conspiracy theories were starting to abound, and I didn't want the UN headquarters to close ahead of signaling to the broader New York community by their own authorities that the situation was serious.
Dr Jillann Farmer: Yeah. If we had done that, I think it would've been really damaging. Mm. And so we were trying very hard to be a combination of, you know, good citizens in our host country [00:14:00] versus exercising our obligations to protect the people that we worked with. . So it was fast, it was hectic, but I had a little trick that I used every day, and I learned it during Ebola, um, which was, um, in amongst the crazy, every morning there was a little pause when I swiped my card at the entry gates to the UN.
Dr Jillann Farmer: There was a tiny delay before the gates would open, and that was my breath. Mm. One breath. Beautiful. I had a moment to just stop- Breathe and then just step into whatever the day would throw at me. And I remember that so clearly because it just became a little ritual. Stop, breathe, and step through.
Sharee Johnson: And it was very intentional obviously. You were doing it on purpose.
Dr Jillann Farmer: Yes, very much so.
Sharee Johnson: This is a little piece of gold right here. As you obviously know, it was gold in your own life. But this idea that we can be really present or mindful or choose our own self even if it's only for a second or two seconds. Yes. It's so, it's so grounding in place and in purpose and it, [00:15:00] just in ourself.
Sharee Johnson: Who, who I am. I'm a real living person under a lot of stress in this moment, but I can take care of myself with this one breath. It's very powerful.
Dr Jillann Farmer: One breath. And it was I, I ... Every day I was amazed at, at the difference that that one breath made. Mm. And it felt a bit silly that that was all I was carving out was one breath.
Dr Jillann Farmer: But it, you know, it made a big difference to me.
Sharee Johnson: Obviously made a huge difference. And was there other times through the day, did you notice that that became a thing at other times, albeit random, perhaps not ritual and, and regular like that? But were you conscious of taking a breath already or other times at work?
Dr Jillann Farmer: Usually when I was, um, you know, the, the situation at, at was evolving so fast that I stopped preparing slide decks. Um, and I started just whenever I had to present, 'cause I was sometimes, and, and my deputy and I, I had a fabulous deputy there, um, who went on to become the successor of the director himself.
Dr Jillann Farmer: But he and I were sometimes participating in three or four meetings at once. [00:16:00] We would have a bank of computers across our desks and be zipping between meetings providing advice. It was just the, the workload was crazy. Um, and so I just started live beaming the data direct from the Johns Hopkins Public Health website.
Dr Jillann Farmer: And I do remember each time I had to do that, that was another moment for a breath of just like, "Here we go. How are they gonna take this?" You know?
Sharee Johnson: Yeah. Does it seem unreal now? Is there any part of you that feels like this seems like another life or a parallel existence?
Dr Jillann Farmer: Um, I, look, I don't, n- not, not really.
Dr Jillann Farmer: It was a different, it was a different stage. Um, and it was, you know, best job ever. I still can't believe I had an opportunity to do that. And I left intentionally for, you know, very well-considered reasons. But it became part of who I am, so it doesn't feel like another life or a separate thing.
Dr Jillann Farmer: It ended up woven into my DNA.
Sharee Johnson: I think that some of the people listening to our [00:17:00] conversation would think this, this is just wild. How does a GP from Queensland get to be- ... medical director of the UN for eight years during these massive crises? You know, Ebola and COVID and hurricanes. I mean, you don't come from hurricane country.
Dr Jillann Farmer: Oh, I come from cyclone country, though Mm-hmm.
Sharee Johnson: Yeah. I- i- is there enough similarity? I mean, I don't come from either of those places.
Dr Jillann Farmer: Yeah, there is. They're very similar. They're very, very similar. I think they're actually the same weather phenomenon, just different names in different parts of the world.
Dr Jillann Farmer: Mm-hmm. Um, but the difference for me was the lat- my, you know, in, in that very early bit, um, was my- just that vast difference in community response. You know, I w- my head was full of the images of Hurricane Katrina and how law and order had broken down. Um, I found that the level of s- of sort of like ride it out advice that was being given to the American public was not commensurate with all of the education we receive in Queensland about that.
Dr Jillann Farmer: So I had measures in place. Like, I was ready for things to shut down [00:18:00] for four or five days, 'cause I just thought, "Okay, I'm just gonna go into cyclone mode here." Mm. And I did. So I did all of the things that I normally would do, um, to prepare my home in Queensland for a cyclone, and I prepared my tiny New York apartment as best I could.
Dr Jillann Farmer: Mm. Including tape on windows and, you know, things like that. Yeah. Moving stuff away and putting lots and lots and lots of Ziploc bags of water in the freezer, instead of going out and panic buying bottled water. So, um, I was well prepared. Yeah. Not for Ebola and not for COVID, but I grew into those roles.
Sharee Johnson: Yes. What's your reflection culturally and, you know, the cultural difference that you experienced to go and work in America, and the expectations you had that some transferred, some didn't, to that culture. What's your reflection when you come back to Australia and you know, we have medical people from all around the world that work-
Dr Jillann Farmer: We certainly do. Yeah. So I have many reflections on that. Um, so the first one was that one of my colleagues, um, who had lived and worked in the US for a while, um, sort of gave me a little bit of a forecasting shot, [00:19:00] and she said, "Just be ready for the US to be very culturally different from Australia." We all think- Mm ... that we're culturally alike because we have so much US culture coming across our televisions.
Dr Jillann Farmer: Um, and so we think that we're very similar, but Americans are culturally very, very different from Australians. ... And my first hint of that was the level of mistrust in government around the, the hurricane. But to be clear, I never worked in the United States. No. I worked- No ... in international territory.
Dr Jillann Farmer: Mm. Um, but I had lots of contact with, um, doctors and other health professionals in New York, both through preparedness and through my own need to s- seek healthcare. The, the thing that I always felt that I had an easier job than other directors in the UN, because it is a huge challenge bringing together a team from every dif- you know, corner of the globe.
Dr Jillann Farmer: And one of the things that I miss was wandering down the halls of the UN medical service, and in the space [00:20:00] of, of 50 meters in a hallway, I could hear four or five different languages being spoken, and it was lovely. I really enjoyed that, and I loved that people could collaborate with colleagues in the language that they chose, and flip back and forth seamlessly between.
Dr Jillann Farmer: I was always envious of their ability to do that. But my job- was easier than some other directors because medical culture seemed to be the ties that bound us. And, um, we could always return to, um, our desire to help, our desire to, um, you know, minimize harm, promote health. There were some core values of being health professionals that allowed me, in some regards, to transcend what cultural differences there may have been because of, of ethnicity, language, religion, or geography.
Sharee Johnson: Mm-hmm. Mm-hmm. It's very tempting to just zoom forward, it's so interesting. I just wonder if we can go back briefly. Mm. Before you, um, before you [00:21:00] went to the UN, you were involved in safety and, and, you know, some other kind of- Yeah ... more global considering roles, let's call it, or, you know, bigger system considering roles at Queensland Health.
Sharee Johnson: Can you tell us a little bit about, I guess, what your interest was in safety, how that came about? Because that wa- that's, again, a step outside of the, what people might imagine a GP does in their room with their patient. Um, may- Yeah ... maybe just walk us through a little bit about how that evolved in you, because it seems like that was a part of the steps towards the UN.
Dr Jillann Farmer: It definitely was. It definitely was. Um, but the story actually goes back way, even before I was a GP. At least this is my assessment of what shaped me in that direction. Um, I was a first-year medical student at UQ (University of Queensland) and, um, I had a friend who was really struggling. He was pretty confident he was gonna be kicked out. Mm. And he thought that if he got elected into the student union, that he would be less likely to be [00:22:00] kicked out.
Dr Jillann Farmer: So he wanted to run, um, to stand for a medical representative on the student union council, but he didn't want to do it alone. He wanted a running mate. And I went, "Yeah, sure. Put my name on the posters, that's fine." And so we had no money, no backing, no nothing, and we ran a little campaign with a little hand...
Dr Jillann Farmer: I, I, like I hand-painted the posters and, you know, we had this campaign slogan, you know, one Fred, two Jillann or whatever. Um, but I'm not gonna name my former colleague. Um, but... And he was a, a weightlifter, and he was a very big, beefy weightlifter. And partway through the campaign, after the nominations had closed and everything, um, he decided to withdraw.
Dr Jillann Farmer: And he started walking around lecture theaters saying to people, to all the medical lecture theaters, "Vote for her or I'll rip your bloody arms off." Oh, and that was how I got elected to the student union. And then,
Dr Jillann Farmer: um, Mike took me under his wing and I started learning how, um, the student system worked. Mike was, at that time, the Education Vice [00:23:00] President who supported student appeals, and I then succeeded him into that role. I became the Education Vice President, of UQ Union in my third year. So I was the med rep in second year, - Education Vice President in third year.
Dr Jillann Farmer: And in that period, I, um, in the EVP role, I was- dealing with a lot of students who needed advocacy around academic exclusion. And then the opportunity came to stand and be elected President of UQ, and, um, I did that, and I was. And so that was for me one of those sliding doors moments where my whole perspective on medicine, and systems, and people changed because I, I, I stepped out of the, um, I stepped out of the very homogeneous culture of the medical school into an environment where people were performing at an incredibly high level because I was suddenly sitting on the university senate and the academic board, and I got to see, um
Dr Jillann Farmer: And I got to see how systems worked. I actually got to see how [00:24:00] systems could exclude people with disability. I got to see how people with, uh ... You know, like I was representing and advocating for medical students who were recovering from mental health conditions, and arguing, like arguing tooth and nail with the dean to get them back in.
Dr Jillann Farmer: And, um, and I saw then as well how different the approach of the faculty of medicine was to the approach of the other deans, and that really got under my skin. And so, um, I, I then left and, you know, transitioned, you know, and, and went back into med school. Interestingly, my grades went up by a whole GPA point because I think I learned to learn fast while I was surfing student politics.
Dr Jillann Farmer: Um, but I, well, I went through and graduated, but I was a, um, a rural scholarship holder So I went around a few different places, and I think that's when my passion for patient safety really got ignited. Um, where I could see that... And this was Queensland before credentialing, before scope of [00:25:00] practice, and I got to see some really unsafe practitioners, um, who were unchecked, unfettered.
Dr Jillann Farmer: And there were times when literally it was me at PGY one and a half was standing between a consultant and a patient to prevent harm, and that just wasn't right. It shouldn't have been the case. I had backup from some other senior staff who, um, for whom I retain lifelong gratitude. Um, they used to even let me switch bed cards so that we could keep patients safe and, um, it was a, it was a really formative period.
Dr Jillann Farmer: And then after that, eventually, um, I, you know, it all sort of came together. I, I knuckled down and got my GP fellowship because I kind of thought I couldn't mooch around doing nothing, you know, with formal qualifications forever. And then once I got my GP fellowship, um, I applied to, for a job with the medical board, um, in the complaints space.
Dr Jillann Farmer: And I didn't get that, but they asked me if I would step into a role under what was then called impairments. [00:26:00] And I had never done anything like that before, but it ticked a few of the boxes that had formed during my student union period. And so I set about reforming how the medical board dealt with doctors who were struggling with substance abuse or mental health challenges.
Dr Jillann Farmer: And I think I made a difference. So I di- I did that for a while, and then I went to Medicare, and then I ended up with just a cold call when I was sitting in the car park waiting for a different job interview. Um, would you come and be a director of medical services at this little facility? And I did that.
Dr Jillann Farmer: And from there, patient safety and then off to the UN. That's the CV in a nutshell. So they all look very logical now in retrospect. It never felt intentional. It never felt like I was creating path. I just chased the things that I thought would be interesting and that fed that part of me that wanted to make a difference.
Sharee Johnson: It sounds like, Jillian, that actually these, some of these accidental things that happened at the start or things that happened purely because you were open or curious or willing, a willing friend, um, that you discovered some parts of yourself that you didn't necessarily- Absolutely ... know were [00:27:00] sitting there.
Sharee Johnson: I
Dr Jillann Farmer: mean, I'd always been a rabble-rouser. I was I think I led the student rebellion in year 10, so.
Sharee Johnson: So there was a p- a personality streak here. But did, did you grow up rurally?
Dr Jillann Farmer: I grew up in Rockhampton.
Sharee Johnson: There's such strong values coming through here that are evident today as well.
Sharee Johnson: And it's a formative time, those late teens and those early 20 years- Mm ... the 20s where we separate some of our values are different from our parents. We evolve, if you like, at, at that period of development. Do you feel like, um, you were honoring your values and/or- The values were, were shifting or changing because of your experience.
Sharee Johnson: It seems to me both of those things were probably happening.
Dr Jillann Farmer: I think that the biggest .. I really do need to, um, acknowledge the, the contribution of my parents, especially my mother. Mm. Um, and, you know, even though there's many things in the Catholic Church that I don't agree with, I had the privilege of a Catholic girls' school education.
Dr Jillann Farmer: And [00:28:00] whatever you may think of Catholic nuns, and even if they may not badge themselves the same, they were fierce feminists. Mm. And they, they, you know, they contributed to the ethos, um, from my mum especially, that there was no challenge I couldn't rise to. Th- th- that really was the you can do anything ethos.
Dr Jillann Farmer: And I know that th- that not everybody in a Catholic school has that experience. That was, that was my privilege as a, um, you know, an academically gifted, um, and, you know, white middle class kid. It's not the same for everyone. But the, you know, the Sisters of Mercy, um, all the way through education it was a, it was about that you have an obligation to use what you have for the benefit of other people, not just for yourself.
Dr Jillann Farmer: Mm. And that was definitely something that, that I, I internalized, and I continue to feel that way, that it shouldn't just be about enriching yourself. It should be about ... You know, it's not ba- bad to, to become economically viable as a result of your talents and skills, but if that's the only thing, I think you end up a bit hollowed out.
Dr Jillann Farmer: Mm. Um, [00:29:00] and so there was that. But the area in which I deviated most probably from my parents was, um... And it didn't, my realization didn't come until I moved to New York and was working in the UN. And I had y- you know, a moment of realizing that my head was full of a whole pile of racist, you know, well-intentioned, but racist assumptions.
Dr Jillann Farmer: Mm. And I remember it very, very clearly when, you know, I had that moment when I was reflecting and it was like, "Oh my goodness, that's really, really off." And it was, you know, it was not that, um, my parents or even the culture I grew up in was rabidly hateful towards people of other races, but there was just a quiet assumption that they really weren't terribly capable of doing very well, and that, you know, you poor things, that's the best they can [00:30:00] do.
Dr Jillann Farmer: And I carried that trope into my very early work at the UN, and I remember it very clearly. I had been out in, um, in one of the peacekeeping missions inspecting a field hospital. And it was really not up to standard. It was way below standard. And the, the doctors who were working there, um, from a country that I will not name, they were incredibly proud of what they were presenting to me.
Dr Jillann Farmer: And I, um, I remembered not wanting to challenge them about that because this thing in my head was, "Oh, the poor things, this is probably as good as they can do." And I went away and thought about that. And, and I realized that that was completely the wrong mindset because what I needed to do was recognize that these, um, colleagues were every bit as intelligent as I was, had every amount of potential that I had, but there were barriers that we needed to remove for them so that they could fly.
Dr Jillann Farmer: And so [00:31:00] the dialogue then became around what is it that we can do to equalize this playing field. And from that spawned an enormous body of work, which I'm very proud of. Um, when I entered the UN, we did not have any documented auditable standards for healthcare facilities. Mm. And so I brokered a partnership with Joint Commission International and set up a team, and there are now, um, UN standards for he- and they're auditable.
Dr Jillann Farmer: And so now, um, governments who want to send their doctors into the field know that they have to be adequately equipped and they have to be adequately trained, and those standards are one of the, the artifacts that I'm very proud to have left behind.
Sharee Johnson: Mm. Well, it's gotta create more safety for the, for the doctors for a start- Absolutely and their patients and, and the rest of the team.
Sharee Johnson: I wanna pause. I think there's so many examples here of recalibration, and you've just given a beautiful example of self-awareness and the mindset, and we'll go there in a little bit about how [00:32:00] important in leadership self-awareness and, and mindset and being able to shift our mindset is.
Sharee Johnson: But before we go there, what have you learned in all these things you've told us about so far about recalibrating? What's the, what are the skills or the resources or the people that help you make those shifts that you ma- you've made lots of during your career and in your personal life?
Dr Jillann Farmer: The first thing is that it's, it's a, it's a muscle that grows when you use it.
Dr Jillann Farmer: Mm-hmm. I think I started doing that very, very early in life, 'cause I went to seven different primary schools. Wow. You know, my, my dad was, um, a, a commonwealth government worker, and we were transferred a lot. Mm. And, um, I just kept moving and needing to sort of restart.
Dr Jillann Farmer: And, and I think that was the first set of just rising to challenges and, and learning and establishing, you know, new networks. That, fortunately, my parents stayed still for the entirety of my secondary schooling, and so I didn't have that level of disruption. But then, of course, it [00:33:00] was, you know, off to uni and, you know, coming from the country into university.
Dr Jillann Farmer: So I think it's, there is a skill set there that, you know, learning to adapt and change and move into different environments. Um, the other thing that we haven't spoken about is, um, is I, I, um, I trained extensively at, in martial arts. Mm. And I think that, that, um, that a- awareness of self and awareness of the impact of emotions on actions is something that I really gained from martial arts.
Dr Jillann Farmer: That, um, you know, it is very easy when someone is thumping you to get angry, but it doesn't actually really help you execute the plan that you need to execute. And I do remember having a moment, um, it was a, I had just done my, um, I had just done my first black belt grading, and I was sitting, waiting for a job interview at the medical board, which was my first non-clinical job, my first, other than the student union [00:34:00] presidency.
Dr Jillann Farmer: And I, um, I was sitting there, and I was quite nervous because I, I, I really wanted to do something different. And I was sitting there, and it was only a few weeks since I'd, I'd done my first black belt grading. And I was sitting there and, and I just, for some reason I had this little thought, going, "Hang on a minute, nobody in this room's gonna hit me."
Dr Jillann Farmer: And it was just like- Oh, I'll be okay ... "That's amazing. Nobody's gonna hit me." And I just, I just completely relaxed, and it was just like, yeah. And I think, you know, I've been helping some people to have that sort of transformation in their thinking. Even around, um, specialty exams, you know, some people, you know, in medicine we are trained over and over and over again that anything other than perfection is completely unacceptable.
Dr Jillann Farmer: Yeah. But when you look at reality, um, there are many medical exams that are actually what we would call low stakes. They may feel incredibly high stakes, because it might be your exit from the [00:35:00] training program. But certainly a first attempt, um, is actually a low stakes situation. Nobody's gonna die. No one's gonna lose a limb or an eye.
Dr Jillann Farmer: The sun will come up tomorrow, and you'll still have a job. You know, the- And you'll get another go next time ... life w- and nobody's gonna hit you. Yeah. Even better. Fantastic. So, so I think it's that, um, thinking about, um, so there's, there's two key things, is getting it in perspective about are my emotions running away with me here and, and making this feel a lot scarier than it is?
Dr Jillann Farmer: Mm-hmm. There's that, and then there is this lovely thing that I think ACRRM (Australian College of Rural an Regional Medicine) um, was really the people who enunciated this for the first time, which is clinical courage. Mm. And I think it was that clinical courage ethos that I was tapping into at the UN when I was rising to all of these challenges around, um, you know, chemical weapons and exotic viruses and, you know, wartime environments and, and, [00:36:00] you know, stuff that I, I had never been trained to deal with.
Dr Jillann Farmer: Mm. But recognizing that I might not be the world's best at this, but I am the person who's here, and I have to do this, and I will do the best I can, and it will probably be good enough. And I think that, the culture of perfectionism is good if it encourages us to strive. It is bad if it discourages us from stepping up.
Dr Jillann Farmer: Mm. And I think that, um, that clinical courage translated into courage in other aspects of work is a really important thing for us all to carry. Mm.
Sharee Johnson: We're such complex beings, I can't help but think that the discipline of martial arts has been really grounding for you too. Just the, just the discipline of it, that the moves have, you know, there are things you can do and things you can't do.
Sharee Johnson: Mm-hmm. And it's as much a mental practice as it is a physical practice. And so- Yes ... I think, uh, these, these outside of medicine, they don't, they don't get enough profile for my mind. I think, you know, people sort [00:37:00] of, um, you know, blow off yoga. A- actually, any team sport, any martial arts discipline, any, um, practice of going for a walk every morning to start your day, these things all make us steadier, give us more physical confidence in our body.
Sharee Johnson: Yep. Help us have moments to notice what our mind is doing. I just want to kind of savor that for a moment.
Dr Jillann Farmer: It's also the, to learn that imperfection is okay. And I actually intentionally set about drilling that into myself with, um, music studies. Mm-hmm. So I, I kind of recognized that I was a bit too obsessed with perfection, and so I just intentionally put myself through the very stressful and humiliating experience of studying a musical instrument.
Dr Jillann Farmer: Mm. And, you know, I am never gonna be very good, but I love it. It's fun. And I learned that actually missing a note when you play is not the end of the world. And, you know, [00:38:00] that's okay. And so it became, for me, a place where I could just really mess up without consequence, and that's actually good. Mm. That was a really helpful thing.
Dr Jillann Farmer: But I also remember I was, um, I was participating in a, um, a classical guitar summer school in the UK. So I went along and, um, part of this was you get put into an ensemble and you get four or five days to prepare, and then you perform in a concert. And, um, we had, for some reason, I, I, I do not understand why I got put into this group that was playing an incredibly complex piece of Bach that had been adapted for classical guitar.
Dr Jillann Farmer: And we had four days to rehearse, and it was a train wreck. It was an absolute train wreck. And we were all sitting in the green room just with our faces on the t- this is a, this is a train wreck, this is a train wreck. And our coach/ you know, conductor, who was the arranger who'd prepared it, he said, "Just trust the music.
Dr Jillann Farmer: Just go out there and do your [00:39:00] best and you will be fine." And we took our little train wreck out onto the stage, and magically it just all came together, and everybody was saying to us, "How did you do that in four days?" We were all looking at one another going, "We don't really know."
Sharee Johnson: And how did you feel? How did you feel?
Dr Jillann Farmer: Oh, amazing. Amazing. You know? And it's still one of my favorite pieces of music- Yeah. So the- ... to listen to, not to play
Sharee Johnson: So the, the risk was worth it, and the effort, the novelty, the hard work was worth it, and there was also a trust in, in each other at some level there in that.
Dr Jillann Farmer: Yeah, there definitely was. But it was also for me very much about, again, no one's gonna die. Yeah. No one's gonna lose a limb or an eye. The worst that can happen is that I'll be humiliated. Yeah. And, and humiliation, whilst extremely unpleasant, um, if it's humiliation you choose to bring on yourself, it's not harmful.
Sharee Johnson: Yes. Exactly. So now, you know, we're stepping into some of our other topics.
Sharee Johnson: But before we, uh, get there, I- I've got this question here: Has medicine asked things of you that you weren't expecting? I think we've- ... [00:40:00] covered that. But I wonder, um, you know, the question is, you know, what positive and negative things you weren't expecting and unintended consequences. Have there been... it sounds like, you know, this story is full of unintended consequences that you've been able to embrace and welcome and, um, contribute to.
Sharee Johnson: Is that, is that a fair-
Dr Jillann Farmer: Yeah. I, you know, the UN story is kind of cute because I, when I was a very little girl, I used to want to work at the UN. I used to read Phantom comics, and Diana worked at the UN. Mm-hmm. And I thought, "That's what I want to do. I want to work at the UN." And then, um, at school we ha- had this book that all the kids come into school in their, on UN day, in their national costume, and I was really disappointed that my mother couldn't tell me what the national costume of Australia was.
Dr Jillann Farmer: Yeah. Um, so I had this little idea about working at the UN, um, as a kid, and I never expected that to happen. And then when the opportunity came up, it was like, "Well, gotta do this. That's gonna be fun."
Sharee Johnson: We were talking before we started about this sense of [00:41:00] feeling trapped that, that, uh, medical doctors often have in their mid-career.
Sharee Johnson: Mm. Is this a good place to reflect on that- Yeah ... from your experiences?
Dr Jillann Farmer: Yeah, so, 'cause it is actually exactly the right place to reflect on it. Because I was sort of mid-career. I was about 47 years old when I applied for the job at the UN because I really felt like I just didn't have- Um, like any other challenges that I could step into within Australia.
Dr Jillann Farmer: It's like I've done the things that I wanna do and it's sort of fun, but it's not really fun anymore, and maybe it's t- And then I, um, there was this, you know, an interesting series of events happened that led to the UN job, and one of them was, um, recognizing that I needed a little bit of, um professional development around the exercise of power, and it's a complicated story that I won't go into.
Dr Jillann Farmer: And I found a course at Harvard called Women and Power, and I went off to that. [00:42:00] And there were a few women from the UN there, and I just remembered thinking, you know, listening to them participate and engaging with them, and thinking, "You know, you are not so terribly better than me. I think I could compete for a job in your world."
Dr Jillann Farmer: And on the way back home, someone handed me a copy of The Economist with a job ad from the UN in it. So I took out a subscription. And at that point, I was ready to leave medical jobs. Mm. Uh, because I didn't even know that the UN had medical jobs. But I knew that I had lots of other skills, and I thought, "Okay, I'm just gonna find some jobs and apply."
Dr Jillann Farmer: Um, but then the very first edition that landed in my letterbox had the medical director's job advertised in it, and it just felt like the planets aligning. So I think that willingness to even contemplate something outside of medicine can l- gets you to look in other places and see other things. And the other thing that I, um, have learned is that going to non-medical events is a really important thing to [00:43:00] do.
Dr Jillann Farmer: I think that medical culture can be very insular, and we can, um, we can get stuck in our own bubble of, of pain. And my moment of realization came when I had, I had a gazillion frequent flyer points. Um, and this was even pre my UN days. I had a gazillion frequent flyer points, and they were gonna expire, and I had exactly enough fl- points to get a first-class flight to Singapore.
Dr Jillann Farmer: Great, I'm gonna go to Singapore first class. What can I do there? There was a health economics conference on there hosted by The Economist, and I had no background in health economics, n- no background internationally. But I rocked up to this conference, and it was amazing. It blew my mind. All of these people from non-medical backgrounds grappling with the big issues in healthcare.
Dr Jillann Farmer: You know, like the health minister from, Indonesia talking about how many islands they had to deal with. Um, how many kilometers of coastline they had to be prepared. So just listening to all of [00:44:00] that stuff lifted my thinking to a whole new level. And so I think if you're feeling stuck, a really great thing to do is, is even just venture into some non-medical conferences.
Dr Jillann Farmer: And in a couple of weeks I'm doing the AICD (Australian Institute of Company Directors) course, and I've intentionally chosen to not do the medical one. I am not doing a healthcare specific AICD course, 'cause I wanna hang out with the cool kids outside medicine.
Sharee Johnson: Fantastic. I think, I think there's more and more examples of that. Uh, Cheryl Martin is another example that comes to mind in terms of doing the Melbourne Business School, um, masters- Yep
Sharee Johnson: you know, with non-medical people. Yep. I think, you know, this is, uh, I love this. I say this every week to somebody in coaching, that medicine offers so much but it's a narrow world. It's a small world, and there's so much more beyond that, that, uh, medical skills can, can be applied to. And so just you're a living, breathing example of that.
Sharee Johnson: Mm. Thank you. Let's talk about mindset and awareness. A lot of what you're talking about comes, or, or your reflections at least, even if you didn't know in the moment, your reflections are that you can look back and [00:45:00] see what was happening in my mind and how did that change my behavior?
Sharee Johnson: I was gonna say maybe this is more relevant to trainees who are on the train tracks of medicine getting their qualifications, but I think this is relevant all through medicine, where people get on a train track and maybe they're not doing that meta thinking, that noticing what they're doing and what, how they're limiting themselves.
Sharee Johnson: Do you have any, I'm gonna call it advice, to give people about how to do that, how to practice noticing what your own mind is telling you that may or may not be true?
Dr Jillann Farmer: Yeah. In fact, I used to teach this. I used to train open disclosure facilitators. Mm-hmm.
Dr Jillann Farmer: And that metacognition is actually a really important skill, learning to think about thinking. Yeah. And what am, what am I feeling? What am I thinking? And you're right, uh, I think it's unrealistic to expect people to be doing it in the moment. Um, something we haven't talked about is my other specialty, which is medical administration.
Dr Jillann Farmer: So in between the hospital job and the patient safety center job, I [00:46:00] completed my fellowship in medical administration. And like many, um, trainees, every time they would ask me to write a reflective piece, I would roll my eyes and ugh. And I remember saying to one of my colleagues, "If I have to do much more reflecting, I'm gonna turn into a disco ball."
Dr Jillann Farmer: Just, you know. Thank you. But credit where it's due, it's a very powerful tool. And so, um, I think, I don't, I don't wanna be turning people into disco balls, and I think if it becomes burdensome, you become aversive to the practice. But I do think that, um, where you have a thing that, whatever the thing is that's happened, be it an interaction with a patient or with a colleague or, um, a clinical scenario, or
Dr Jillann Farmer: There, there are things that stick in your head. And there's a difference between ruminating and reflecting, and I think it's very important. Uh, and for me, the trigger is if I find myself ruminating, that is a [00:47:00] key trigger that I need to reflect on what was happening. What was I thinking? What was I doing?
Dr Jillann Farmer: What do I recall are my physical, visceral responses? What else was happening in the room? And, and I think that, um, j- that, that moment to think about yourself and r- reflect on what, what are the things that I can learn from this can help transfer, transform what can become a cycle of negative rumination into a stepping stone forward to improvement.
Dr Jillann Farmer: And that's definitely been something that, um, I Picked up along the way. And I think the foundation's definitely in martial arts. You know, you get smacked in the face, you're gonna learn that there was something wrong with your technique, and that's a very immediate bit of feedback. But you do, you learn to analyze yourself.
Dr Jillann Farmer: Um, and I think an- another very important learning for me w- with, when I stepped into having my own karate school, I noticed one day that my students were all fighting with their chins stuck out, and I couldn't work out [00:48:00] where it was coming from. And then one day I saw myself in the mirror, and I was doing that, and they were all copying me.
Dr Jillann Farmer: And so that was, again, it was a literal reflection. Yeah. It is. I saw myself in the mirror. So it was a chance to recognize as well that, um, that the behaviors of people around us might be more influenced by our own behaviors than we recognize. So those moments to stop and think, "What am I seeing? What am I doing?
Dr Jillann Farmer: What am I saying? What's hooking my head? What's, you know, what's eliciting a limbic response from me?" Those things are very important parts of understanding who you are and understanding how you work, and in that lies the key to working out what will make you happy.
Sharee Johnson: Yeah. And you're reminding me back to the, the one moment at the, at the UN gates with your, with your card.
Sharee Johnson: That these, these reflections and these learnings don't happen when everything is full, and it's fast-paced, and there's lots of pressure. You know, they happen when we're in the shower, they happen when we go for a walk. We happen in the moment that we take a pause and we notice in the mirror, "Oh, I've got [00:49:00] my chin stuck out too."
Sharee Johnson: It's, so we, we need actually space. It doesn't have to be huge amounts of space, although sometimes we do if people are feeling burnt out or really struggling or feeling really stuck and trapped, they probably do need a bigger space than a s- a second or two every day. But these- Yeah
Sharee Johnson: these spaces is where we actually discover or see or notice these, these choices. I think the, the problem about pressure and fast pace is we forget our choices. And the other image that's coming to my mind is you with your bank of computers at the UN and thinking how the heck did you maintain any, any sense of, "I've got a choice in this."
Sharee Johnson: Do you have a sense looking back that you did remain ... Did you have enough practice and habit by then to, to still have access to your metacognition in that, in those moments?
Dr Jillann Farmer: Oh, very much so. You know, like my, my deputy and I were We were laughing about how insane this was. You know, it was just like, "This is crazy.
Dr Jillann Farmer: This, this, this is absolutely nuts, but this [00:50:00] too will pass."
Sharee Johnson: do you think it was important to have a trusted other person there to-
Dr Jillann Farmer: Oh, God, yes. You know, Bernhard and I were an A-frame yeah ... you know, we leaned on one another. And in fact, one of our practices that continued through the crazy was that every day, every day, unless one of us wasn't in, in the office, we would sit at 11:30, before it got busy, we would have our lunch together every day.
Dr Jillann Farmer: Mm. And that was a really important time of support for both of us because, um, there really, within the UN system, the, my first big learning was that health is an overhead here, it's not the main game. And so that was a big recalibration for me- Yeah ... to come to terms with the fact that some of the stuff that I was promoting wouldn't be the highest priority for the people I was promoting it to.
Dr Jillann Farmer: So Bernhard was a really key support and sounding board. Um, and that moment together, you know, even if it was only 15 to 20 minutes, we would always take lunch. And that's, you know, you have to eat- ... and we may as well make it useful.
Sharee Johnson: Yeah. You're again showing [00:51:00] us, Jillann, how important this pause is.
Sharee Johnson: You, you need to prioritize it. Somebody's got to prioritize it and, and it can be you.
Dr Jillann Farmer: That's exactly right- 'cause no one else would, would do that. No one else would prioritize that. Yeah. And you know, I had sort of a rule of thumb that the only thing I would've aborted my lunch for was a cardiac arrest really.
Dr Jillann Farmer: Mm. Mm. You know, other than that, 20 minutes is not gonna kill anybody.
Sharee Johnson: I just feel like we're having a moment of really serious leadership here. I was talking with a, um, emergency doctor last week who, uh, makes a priority of having food every single shift and modeling it and insisting that the trainees- Mm
Sharee Johnson: and the doctors have some food every shift. And I, I said to that doctor, "You know, this is such a gift that you're giving the people around you as well as yourself to be so consistently prioritizing that this must happen, even if it's only for 15 minutes." Mm-hmm. It's, it's not- Absolutely ... not negotiable.
Sharee Johnson: Yeah. Let, let's move because there's lots more things to talk about. So, um, let's, let's get to A Better Culture. I think that's a really important piece of work that's been [00:52:00] happening and as you told us at the beginning, continues to happen. So maybe, um, for the people who've never heard of A Better Culture, certainly our non-doctor audience or our, our doctor audience beyond Australia won't know what we're talking about.
Sharee Johnson: So can you just give us a short version of, of what that is? Sure. And, and give us the update about where we're going and how it's, how- So, um- ... it's evolving.
Dr Jillann Farmer: A Better Culture- It was a Commonwealth funded, so funded by our national government in Australia, a project that was, um, developed in response to a thing called the Medical Training Survey.
Dr Jillann Farmer: And the Medical Training Survey is a nationwide survey of, um, early career doctors who are, before or during their enrollment and completion of a specialist training program. So we have a couple of years where people are what we call pre-vocational. They haven't really siphoned off into a training program.
Dr Jillann Farmer: For some people, that period extends anywhere up to five or six years whilst they complete non-accredited jobs and eventually get onto a training program. So the MTS captures all of those people before they get a specialist [00:53:00] ticket. And, um, the, the results of that survey year after year after year were showing very high levels of reported bullying, harassment, racism, and discrimination.
Dr Jillann Farmer: And so, um, the Commonwealth partnered with RACMA, the College of Medical Administrators, which I mentioned earlier as my other specialty, um, to develop, uh, to implement a project and the, the, the key remit of the project was to design an agreed approach that could address these year-on-year findings. So, um, A Better Culture was born.
Dr Jillann Farmer: Originally, it was called The Culture of Medicine, but I didn't feel that that was appropriate because doctors operate in ecosystems, and it's not-- I, I felt that that was pejorative, and it was blaming the medical part of the healthcare system for something that's clearly a system-wide issue. You look at the data from nurses, um, as well, and their experiences are as bad if not worse than doctors.
Dr Jillann Farmer: You know, I talked earlier about how doctors can get stuck in their own little bubble. And my student union experience taught me this, you know, that things [00:54:00] are very different, but they can be equally as bad for people outside medicine, and I feel doctors have an obligation to advocate not just for ourselves, but for everybody.
Dr Jillann Farmer: So we changed the name of the project and the branding and everything away from the Culture of Medicine to A Better Culture, seeking to broaden its impact and make it clear that what was needed was an evolution of culture in healthcare full stop. Um, the project ran for two and a half years. We managed to stretch our two years of funding out to two and a half years, and developed a number of key artifacts throughout the project.
Dr Jillann Farmer: The final two, um, of the formal project, there's, um, there was a, a report about the whole project with a series of recommendations to all levels of the healthcare system from, um, the federal health minister, directors general of the jurisdictions or training colleges and local managers. The, the entire sweep.
Dr Jillann Farmer: And then there was, um, a, um, a second report that was authored by [00:55:00] the First Nations medical officer in our team and a First Nations committee on cultural safety and cultural governance. So those two reports were the capstone, um, outputs, but the project then did not implement any funding at all for implementation.
Dr Jillann Farmer: So RACMA have, um, have kept me on, um, throughout the last year on a, sort of a, an ad hoc basis to continue to, you know, funding grants, um, progress some of the work, and we've got a couple of things now getting very close to fruition, um, which I can't really talk about yet because they are still subject to negotiation.
Dr Jillann Farmer: But we are hopeful that, um, the incredibly hard work that our hundreds of volunteers put in to develop the, the intellect behind A Better Culture, that we can now translate some of those things into very tangible, um, products that will be applicable in the Australian healthcare sector. So we might not have the immediate, um, uptake that we had hoped [00:56:00] for, but I certainly learned, um, at the UN to play the long game, and I learned in martial arts that if one punch doesn't knock your opponent out, you just need to find somewhere softer, so.
Dr Jillann Farmer: Um, we're just continuing to look for spots that we can, um, leverage the learning and the incredible output that people gave us.
Sharee Johnson: And the measures that you're interested in, Jillann, and they're, they're principally around those four things, d- discrimination, bullying, harassment. Th- that, that's what w- you're measuring?
Sharee Johnson: Um, so, so that is the de facto measure- Yeah ... um, y- because that's what we were set up to, to address. So that was always the, you know, the key goal. They are gonna be really difficult to shift. And I, you know, I think that the, um, the, the idea that a project to address that after it had been rigid for years, to set it up with a two-year horizon was never gonna address the problem, and I was very clear about that from the beginning.
Sharee Johnson: That this is, we're not gonna fix it. We will give you the signposting of how to fix it after two years, and it [00:57:00] will be a solid, very well-developed piece of work, but we won't fix it. And I, I want to go back to that time. I remember talking to you at a conference and saying, "Two years? What can anyone do with two years?" Kind of thing. And to just acknowledge your, your long game, your optimism about that, that, well, something has to happen and we need to start somewhere. Yeah. These numbers are, are not okay, and they can't stay that way. And I, I know that you, you know, lots of people talk about equality, and I think that you talk much more about equity.
Sharee Johnson: Can you, can you help our people think about that a little bit? I think that's a really important thing for us to get really clear about.
Dr Jillann Farmer: Yeah. So equity and equality. So I'm not the great expert, but I think if you think back to, um, my story about visiting the field hospital and realizing that what I needed to do was address the barriers that were stopping these colleagues from, um, another country performing to the full limit of their potential.
Dr Jillann Farmer: That's really the best example I [00:58:00] can give you of an equity lens. Um, so the other thing that I, um, that I bring into this then is the concept of intersectional disadvantage. So, um, it took me a while to come to terms, and this is very much shaped by my experiences outside the UN, but in the US, where I had opportunity to engage with, um, a number of incredibly erudite African American leaders.
Dr Jillann Farmer: Um, uh, one of my connections was the first Black American woman to ever make it onto the presidential ballot in every state, you know. And, and I had another friend who spent many hours as I wandered through Central Park birding with him, sort of educating me about race and politics. What I learned there is that when white women step into advocacy about women, they risk marginalizing other groups.
Dr Jillann Farmer: And the best model for overcoming that is to learn to think about [00:59:00] intersectional, um, privilege and intersectional disadvantage, which means that any one individual brings all elements of themselves to their world, and that might be race, gender, education level, body habitus, income, citizenship, primary language, multiple different things that intersect to put you in a position of privilege or not.
Dr Jillann Farmer: And I think if you, um, h- have never considered equity through an intersectional lens, then you've ... It's kind of the difference between, um, a 2D black and white movie versus a 3D full threa- a 3D full color IMAX experience. Once you understand or have even reflected on your own intersectional privilege, it becomes a lot easier to think about, um, what can we do to lift others up.
Dr Jillann Farmer: And that's where I loop back after that detour into equity is about addressing the barriers that stop people from [01:00:00] being able to, to reach the fullness of what they should be able to. Mm. And there's a beautiful diagram that I'm sure many of your, um, viewers will have seen, which is of the three kids trying to watch the footy match- Yeah
Dr Jillann Farmer: and the different levels of boxes underneath them. But ultimately, re- removing the fence so that they don't need boxes at all is the ultimate step in equity. And that's what I d- you know, that's, that was really the mindset of trying to set up, you know, equitable standards so that everybody would have the same resourcing and the same capabilities, um, once they're introduced into the field.
Dr Jillann Farmer: So equality, um ... And, and the other issue that comes up a lot, um, that people can think of as a virtue, um, is this concept of colorblindness, and, um, I'd like to just knock that on the head. Colorblindness is not a kindness. ... My view is that calling yourself colorblind and insisting on treating everybody exactly the same, no [01:01:00] matter their background or the color of their skin, is, um, a stubborn denial of intersectional disadvantage.
Dr Jillann Farmer: And i- i- if you are colorblind, you are in fact intentionally disadvantaging people that the world imposes an enormous amount of disadvantage on. And so you need to be aware of these levels of discrimination, and Australia still has racism issues, has very significant racism issues. And to deny the existence of that simply because one hasn't experienced it oneself, um, is a denial of the lived experience of others, and that's not okay in any form.
Sharee Johnson: Indeed. Can we talk a little bit about leadership? A lot of doctors say all doctors are leaders. Ugh. I meet many doctors who don't know what that means, who don't know if they want that role, who, you know, are confused, I would say, about what that is. I meet [01:02:00] many patients who say, "I don't want the doctor to lead me.
Sharee Johnson: I want them to collaborate with me or see me like I'm a normal person" or... And then I meet many trainees, which we're talking about, you know, bullying and harassment and so on, um, who also feel like, you know, well, if that's the kind of leader that I'm expected to be, I don't want to be a leader for some of the people who are teaching them.
Sharee Johnson: So to me, it seems a much more complicated matrix than all doctors are leaders, and from your reaction, it seems like, uh, you've had something interesting to say. Can you- ... can you share with us?
Dr Jillann Farmer: We are obsessed with the idea that leadership is the only worthwhile destination.
Dr Jillann Farmer: Mm. Mm. And I think that that's, um, i- a- and it's just crazy because if everybody's leading at once then it's just a bit of chaos. So, um, I think that th- this idea that leadership is something that everyone should aspire to, um, I think that's silly. But the flip side of that is that actually everybody leads [01:03:00] something.
Sharee Johnson: Mm. Even if it's yourself-
Dr Jillann Farmer: unless they're still a babe. Even at kindy level, you'll see kids influencing other kids. Mm. You'll see kids deferring to another child, asking their opinion. So we see leadership emerging, um, unintentionally in various contexts. And the patient before you might be a leader in their local volunteer organization. They may be a leader of their own family. So I think this distinction that all doctors are leaders, well, yeah, but only to the extent that all people are leaders.
Dr Jillann Farmer: It's not something that medicine magically confers on you. Um, and I am very much of the view that, yes, there can be individuals who, through formative experiences, grow up with what people label as natural leadership traits, but often are just the result of circumstance, education, role modeling, et cetera.
Dr Jillann Farmer: Um, but leadership can be taught. It's a helpful [01:04:00] skill set to have, good leadership. Mm-hmm. But it doesn't have to be... Y- you're not a failure if you don't wanna be a director. You know, it's perfectly fine. Look at me in the end of my career. I'm happiest in an emergency department just cracking on treating the patients 'cause it feels like very high-value work.
Dr Jillann Farmer: And I don't need to be leading anything in that context and in that environment. So, um, I don't... I think that that statement is wrong. It sets us up for failure. I think doctors do a far worse job systemically of growing people in management and leadership capability than nursing does. Nursing has managed to develop a very nice and cumulative career path that grows people into leadership and management roles, whereas medicine kinda just throws people in and says, "Well, you're all, you know, all doctors are naturally leaders, so just crack on and do it."
Dr Jillann Farmer: And that can be a very bruising experience.
Sharee Johnson: Maybe I have a particular subset that I work with, and that's probably true. Um, but I think a lot of people in Head of Unit and [01:05:00] Head of Department positions, uh, everybody stepped back.
Dr Jillann Farmer: Mm, absolutely. Absolutely. I learned that lesson in my year 10 school rebellion.
Dr Jillann Farmer: Yes. They were with me until they weren't.
Sharee Johnson: Yes, exactly. And, you know, there's a, a lot of people come to coaching for success- succession issues. You know, I'm, I'm the head of department and I'm trying to cultivate or develop people to step into the role after me, and I'm finding it very difficult.
Sharee Johnson: Nobody wants to or, you know, p- I can't get people to meet with me to talk about that kind of thing. There are multiple different issues. I don't want to make that one issue, but that's a very common theme that people come to coaching for, to say, "How am I gonna help the people in my team become the leaders of the future?"
Sharee Johnson: I, I was interested you said you're doing some work around that, um, mentoring some people into- Mm ... future positions. Do you wanna talk a bit about that and a little bit about your new consulting so that people know-
Dr Jillann Farmer: Oh, sure. So, um, so I think that- When, when one is having difficulty growing the next set of leaders, it's often because the leadership models that [01:06:00] they've seen don't resonate.
Dr Jillann Farmer: I remember when I got to the UN, there was an initial really aversive response from the staff because I wouldn't tell them what to do. Mm. Um, and it would've been really stupid of me to tell them what to do because I didn't know the business, I didn't know the people, I didn't know the culture, I didn't know anything.
Dr Jillann Farmer: I was having my very own you know nothing Jon Snow moment. It was just like ... But there was a very fixed idea that the director should direct. Um, but my approach always has been listen, listen, listen. The solutions come. And even that very famous, um, medical quote, "The patient will tell you the diagnosis if you but listen."
Dr Jillann Farmer: Mm. And so, um, I think that for many people, understanding or being able to identify the strengths that they have that they can use in leadership, to not have to become some fake version of themselves- that, by learning to leverage the strengths that they have, they can become the leader that their [01:07:00] team needs.
Dr Jillann Farmer: Um, and I, um, I'm a huge fan of strengths-based leadership development. I am now a vocal opponent of 360-degree feedback methodologies. There's very good evidence that they systematically disadvantage women. Um, women get less actionable feedback, more emotionally loaded feedback, more judgmental stuff. Men get actionable things that they can actually do something about.
Dr Jillann Farmer: And so, um, I had the privilege of, um, completing a leadership course at Yale, and I was introduced to a fabulous tool called Reflected Best Self, um, which is, I can't remember where it came from. It's one of the American states. But it, it reaches back through time to people who've known you f- right from, you know, high school through.
Dr Jillann Farmer: Mm. And you just ask them to tell you about what they thought was best. Mm. And it's an amazing experience. Mm. And it helps you revive the things that might have been extinguished by this constant barrage [01:08:00] of you have to become more like Fred or John or, you know- Mm ... what is it? More Davids at the leadership table than there are women.
Sharee Johnson: Yes, that's right Um, uh, just for our listeners, we will try and put most of these things that, um, Jillann's referring to, We'll certainly put the better culture reports and so on into the show notes and, uh, maybe you can send me something about what you've just said.
Dr Jillann Farmer: Reflected best self, 'cause it is. It's actually something you can do yourself. You don't even need to hire someone.
Sharee Johnson: I'd really love to have a look at that. We, we've just started actually, we haven't been doing 360s in our coaching work for a long time, but in the last two years we really have started doing quite a lot more of them, so that's also interesting to me what you've just said- Yeah
Sharee Johnson: about that in terms of th- that research. When, when you think about going forward, uh, I know that you're thinking about retiring for yourself in, in the coming years.
Sharee Johnson: But when you think about medicine going forward, a better culture, um, you know, these ideas that we've just been talking about, leadership, metacognition, opportunity for people to step in and out of their clinical work, what, what's the future vision of, of medicine and health look like for you?
Sharee Johnson: Pick any timeframe. Well, the big- the big future of medicine [01:09:00] and health for me is as a consumer. I'm gonna be, I'm gonna be on the receiving end of the, um, the tender care administration of the colleagues that I may have helped to train. ... It, it feels hackneyed, but we're at a real inflection point at the moment with, um, with
Sharee Johnson: There's an intersection of many things. One is the general loss of community trust that has permeated the world since COVID. I think, um, there was a lot of harm done, um, through conspiracy theory, through perhaps imprudent and hasty advice. I was part of that. I was doing the best I could with information, but there was an erosion of trust.
Sharee Johnson: And then there's been the amplification of the village idiot in the square being given as much kudos as an erudite scholar who's been studying something for 50 years, and the public doesn't by and large seem to be discerning terribly much between expert advice versus a blogger who's trying to sell a product.
Sharee Johnson: Yeah. And I think that, um, we are at a [01:10:00] real inflection point where that competing with misinformation and disinformation is a really critical thing that medicine and the health professions generally need to do. And we need to stake that territory out very clearly and be prepared to assertively challenge people who are, um, engaging in, um, unregulated conduct, because you can do whatever you like.
Sharee Johnson: If you're not a registered health professional, you can get out there, and it's subject to consumer laws. You can harm people. So I think we need to do much better at helping, um, the public navigate the minefield of disinformation that's out there at the moment. Um, as a profession, um, we have no choice but to work in the AI era.
Sharee Johnson: Um, we've navigated the Google era. I was, you know, never too worried by people coming in with their Google search. It let me know what was actually on their mind. Yeah. This is what you're actually worried about. Let's roll our sleeves up and deal with this. Now people are coming in with an [01:11:00] AI workup sheet.
Sharee Johnson: I did that to my own GP a few weeks ago. You know? Why shouldn't I behave like any other patient? Yeah. And, um, and I think that we need to, we need to be agile in adapting to the, the persisting challenges whilst remaining, um, you know, staunch advocates for the importance of a human connection in medicine.
Sharee Johnson: Um, I feel that some areas of work are going to feel the squeeze as AI models become more and more sophisticated. Um, but the, the need for people in distress to connect with humanity is not going to go away. Mm. That's not going to go away. And so I think the, you know, cultivation of what get called the soft skills, but they're actually the hard skills, of connectedness and empathy, and an ability to move out of your fully medical brain into the space that the patient inhabits, even temporarily, to [01:12:00] understand their concerns and the barriers that exist in the life that they walk.
Sharee Johnson: That's what will allow us to create value in the future. Mm. And, um, Jillian, you've talked about, uh, you know, walking with people in Central Park and learning about intersectionality and so on. Uh, you're so reminding me of the, some of the women that I've worked with who've taught me that. It was a client who taught me even the word intersection- Mm intersectionality a few years ago. And so, you know, we just learn so much from each other in these- Um, ponderous kind of moments where we're open to learning. I think they're so valuable. Um, who helps you? Have you had coaches, mentors, supervisors, teachers that have been important?
Dr Jillann Farmer: Oh, I couldn't... You know, I, I wrote a little post in, um, in LinkedIn a couple of weeks ago about, you know, how grateful I am for the education I had, and I started writing and, you know, wanting to give shout-outs to all the people who've grown and nurtured me over the years, [01:13:00] and it just turned into an Oscars speech.
Dr Jillann Farmer: So, um, I just culled all the individual mentions and, and went with the system level, um, things that had helped me. Um, I can't even begin to name the people who've, who've backed me, who've taken a risk on me, who've been prepared to let me grow roles into my strengths. And I think that's been one of the key things in my own career, is to take a job that might not be exactly what I want, but recognizing a need and then growing the role to fit my strengths and to fit what I, what feeds my passion and helps me deliver with passion.
Dr Jillann Farmer: Um, that's been a, a wonderful privilege that I've had in a succession of jobs where I've been able to grow things. So for example, at the UN, I was basically hired to approve sick leave and disability claims. That's what they thought the job was. But I got there, and I discovered that there was an entire healthcare ecosystem that was not operating with the normal disciplines of a [01:14:00] modern healthcare system.
Dr Jillann Farmer: And so I set up a public health unit. I set up a credentialing and standards unit. I set up, um, you know, a number of things that allowed us to modernize, and of course that was done with, you know, the support of my boss, but the blessing of the member states eventually, 'cause the UN doesn't exist but for the approval of the member states.
Dr Jillann Farmer: So there is the skills of finding the people who will let you be yourself and let you, um, let you leverage your strengths to the advantage of the organization. There's then also the skill of being able to convince them to do that and, you know, to, to generate belief, and I definitely learned a lot, you know, through professional education opportunities.
Dr Jillann Farmer: I have, Always had sort of peer relationships. Relationships outside medicine are incredibly important for keeping you grounded. My husband is a medical researcher, um, who, um, I, I don't think he'll mind me telling this story because he does te- he, he, um, got a full scholarship to Oxford.
Dr Jillann Farmer: So [01:15:00] bright young man, and he could choose any discipline he wanted to study at Oxford, and he was contemplating medicine. And he went around and spoke to lots of doctors, and after talking to lots of doctors, he said, "There is no way I'm studying medicine. They are the most miserable group of people I've ever met."
Dr Jillann Farmer: Mm. And so he went off to university and, and this was in England. It was, um... And so he went off to university and studied his passion, which was science, and went on to have an amazing career in science. But he has kept me really grounded in the fact that there are people, and worlds, and problems that sit outside of medicine, and, um, and I think he's been a really powerful influence on my worldview as well.
Dr Jillann Farmer: I think it's really important to cultivate non-medical friends, and I think that was definitely one of my early strengths, was stepping into that student union space so early. I went off into the student union space dealing with all of the students of the university. Quite a number of my colleagues followed the more traditional pathway of [01:16:00] going into the Medical Student Association and then the AMA.
Dr Jillann Farmer: And so if you stay within that medical ecosystem, you can, um, fail to gain the benefit of that enormous breadth that, um, that sits in the world
Sharee Johnson: Hmm. I think your stories are full of that, where you could see contrast. There w- there would be contrast. Mm-hmm.
Dr Jillann Farmer: Very much so.
Sharee Johnson: Yeah. I can't let you leave, I know I asked you already, but please tell our viewers where you are, because they'll want to know what the photo behind you is.
Dr Jillann Farmer: Oh, yeah. So this is the Wynnum Wetlands. Um, I ... the, one of the other ways I keep myself sane is just lots of activities. Um, and so kayaking is one of them. And this is the, um, the Wynnum Wetlands, and this is a really beautiful area that you can paddle into that, um, almost has a cathedral-like feel. You paddle in and the branches of the mangroves are arching over from both sides, and you can paddle all the way up here, and it's, it's quite a spiritual experience to head in there.
Dr Jillann Farmer: And I definitely [01:17:00] do recharge in nature. So, um, I, I can tell you a campsite that you can be pitched in less than two hours out of New York, where I spent many a weekend, me and my dog and my tent. So getting out into nature is definitely part of my recipe for staying sane.
Sharee Johnson: Sounds fabulous. I'll need to ring you up in a few years and say, "Jillann, I'm in New York."
Dr Jillann Farmer: Where's the campsite?
Sharee Johnson: Thank you so much for your time today. Everything we talked about could be another hour by itself, and I really appreciate you crossing a lot of terrain with me in this time that we've had. I hope that, uh, if you're listening, that you can hear, the twists and turns in Jillann's, career and her work, and also the kind of steady threads that run through all of those twists and turns.
Sharee Johnson: Her commitment and values and, uh, clear clarity and focus about what she's trying to achieve and who she's trying to connect with, are evident. And her openness and her willingness to find lots of different ways to, to keep life interesting for herself, but also [01:18:00] to continue that work. And we haven't really been explicit, Jillann, in saying about you stepping in and out of clinical work.
Sharee Johnson: But maybe we can just finish with that bit, that this, uh, encouragement for people that taking a different turn, doing something else for a while, doesn't prohibit you from coming back to clinical work. And that these- It does not ... can live together.
Dr Jillann Farmer: It does not. And I think that, um, I- I've stepped in and out clinically m- on multiple occasions through my career.
Dr Jillann Farmer: The biggest break I took was when I went to New York, and I was over there for eight years, and before that I had not worked clinically for a couple of years. So, um, coming back to clinical work after sort of a 10 or 11-year break was the biggest one I've done. But I can, I can say authoritatively that it can be done.
Dr Jillann Farmer: And a lot of people are put off by the medical board's requirement for supervision if, you know, if you've been out, and I just don't think that that should worry people. I think that, um, it's a [01:19:00] relatively painless process. It just requires a bit of humility to accept that this is for the sake of patients, but also for your own protection.
Dr Jillann Farmer: And I think that, um, it's a, it's a, it has definitely helped me avoid burnout. 'Cause I will bounce through the emergency department in my 60s, um, without a hint of burnout that I don't think I would be like that if I had stayed in the front lines for the full, you know, 40-odd years of my career. Mm-hmm.
Sharee Johnson: Mm-hmm. That's a beautiful place to finish. Thank you so much for your time, Jillann. Uh, Dr. Jillann Farmer, everybody.
Dr Jillann Farmer: Thanks, Sharee.
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