Ep 26 Dr Janice Tan
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Speaker 2: I think you're really going to enjoy this conversation with Dr. Janice Tan. Janice is a general practitioner in Sydney And is also on the forefront of digital health strategy,
Speaker 2: I love some of the phrases that Janice uses when it comes to digital tech and the fast pace of change. She talks about having an expansive kind of optimism. She talks about considering new tech with optimism and with [00:01:00] skepticism, looking from both of those lenses. And she's really values her clinical time as a way of keeping her finger on the pulse while she's meeting all these, fabulous things that are coming out of so fast out of the tech space. Janice describes coming to medicine with a clear understanding of three things that she really loved.
Speaker 2: She really loved science, she loved talking to people, and she loved problem-solving. And I think it's a beautiful example of thinking about what do you love, what are your strengths,
Speaker 2: Thinking about work from , a practical lens, even on a bad day, would this be okay for me? Could I keep doing this work? And from a position of passion, she describes passion as the foundation. That's the thing that can keep us interested in our work.
Speaker 2: We had an interesting conversation about what's changed in the consulting room, even in the last five years, and Janice talks about really everything has changed in the consulting room, and even the patients have changed because they're [00:02:00] arriving with different information, different kinds of questions, and that's changing the relationship between the, the patient and the GP
Speaker 2: And I think, Janice has some really interesting things to say about the importance of the trust in the relationship between the doctor and the patient, and that as we navigate these new, , ideas, consent for the transcribing tools and many other things, genomic testing as it becomes more online, That trust in the relationship is really important for patients to have a place that they can go and ask questions and really think about what's gonna work for them, and for doctors to have meaningful work that's not somehow superseded or interrupted by, the machinery of AI.
Speaker 2: We also talked about My Health Record, which is relevant particularly at the moment because on the 1st of July we moved to sharing by default. So, uh, we talked about that. We also talked about those real feelings of when you step outside of what you know. So in Janice's case, when [00:03:00] she decided to explore, uh, work in the corporate space as a strategic advisor in addition to her clinical work, that that felt uncomfortable and sometimes still feels uncomfortable.
Speaker 2: And again, I hope that, those of you listening who are thinking about a career change or a portfolio career can really tune into that part of what Janice is saying. Just because it feels uncomfortable doesn't mean you shouldn't do it or that you can't do it. That has some implications for our identity, and it's the identity work or the limiting beliefs work that is the work you might consider doing with a coach if that's part of what's, um, challenging you in terms of decision-making and clarity for the future of your career
Speaker 2: There are some really clear messages in Janice's, view of the world. O- one that she seems to think is particularly precious is the empowerment of patients. And I, I feel reassured by that in the context of big tech and the fast pace of change that's going on that people are expected to navigate. And, um, and she also [00:04:00] named very clearly one of her values, which is this idea of wanting to leave the world a bit better than you found it.
Speaker 2: I found this conversation with Dr. Janice Tan a really encouraging conversation and I look forward to hearing what you think about it.
Sharee Johnson: Dr. Janice Tan is a practicing general practitioner and also a digital health leader who is passionate about transforming healthcare delivery. As General Manager of Clinical Innovation at Bupa Australia, Dr. Tan leads initiatives that leverage emerging technologies and innovative models of care to democratize access to quality healthcare for both clinicians and consumers.
Sharee Johnson: She practices as a GP in South Western Sydney with clinical expertise in women's health, pediatrics, and mental health, maintaining frontline insight while driving digital health strategy. This dual perspective allows her to advocate for solutions that can improve [00:05:00] workflows, reduce inefficiencies, and enhance patient outcomes.
Sharee Johnson: Beyond Bupa, Janice contributes to shaping Australia's digital health and primary care landscape with the Royal Australian College of GPs, RACGP, and the Central Eastern Sydney Primary Health Network, ensuring digital health solutions are safe, equitable, and designed with the needs of both patients and clinicians at the center
Sharee Johnson: I'm really very thrilled today to be talking with Dr. Janice Tan and to be sharing this conversation with you. Janice and I have said hello a couple of times, very in passing. It's the first time that we've got to really have a conversation together. So I'm really curious about learning from her, particularly about digital health, and I, I know that you're gonna really enjoy this conversation and get a lot out of it.
Sharee Johnson: As you all know, Recalibrating with Sharee Johnson is really about trying to help people see the really, the scope of what doctors can turn their, um, skills to and what healthcare [00:06:00] workers are involved in, other than just what we might think of as the traditional clinical work. And, uh, Dr. Tan is a really beautiful example of that.
Sharee Johnson: So, uh, welcome Janice. It's lovely to see you.
Sharee Johnson: Thank you. Thank you for having me.
Sharee Johnson: Janice, as we heard in the bio, you are involved in clinical practice as a practicing general practitioner and many other things.
Sharee Johnson: Can you paint the picture for us and tell us what, I don't know, a month of medical life looks like for you in 2026?
Dr Janice Tan: Yeah. No, I wear several hats at the moment. But I always, always start with, first and foremost, I am a GP. , And I work in suburban general practice in South Western Sydney, um, seeing patients and, you know, on Fridays and Saturdays.
Dr Janice Tan: And the rest of the week, I lead a team of, uh, the clinical innovation team at one of Australia's largest health companies, Bupa. And really, my job there is helping to decide which emerging health technologies are real and which [00:07:00] are expensive optimism, but also implementing them and following through the whole product life cycle as well.
Dr Janice Tan: Um, other than that, I also do hold advisory roles with the RACGP, the Royal Australian College of GPs, and also dabble a little bit with a couple of advisory roles at the Australian Digital Health Agency and the Safety and Quality Commission as well as my local, PHN, the Primary Health Network, which is the Central Eastern Sydney PHN as well.
Dr Janice Tan: Uh, in 2026, one thing I've also found myself writing, I actually found myself writing op-eds something I recently found a bit of a passionate, getting a lot of thoughts in my head on paper and sharing them as opinion, um, on, on major medical media such as The Medical Republic and Australian Doctor as well.
Dr Janice Tan: So quite varied. No day is quite the same, but I think that is sort of variety is the spice of life, and that's sort of how I've designed my career to be.
Sharee Johnson: Hmm. I know when I've heard you talking about the digital work that you [00:08:00] do, that you've, uh, always referencing the patients and thinking about the patients.
Sharee Johnson: So that clinical, those two days of clinical work on a regular basis seems important for your, your general understanding of the landscape.
Dr Janice Tan: 100%, and I think it's very important to continue keeping your finger on the pulse, so to speak, by working in frontline general practice just because, um, acknowledging that this healthcare landscape is always changing and it is never quite the same, you know, six months before, especially in this world of emerging health technology and AI.
Dr Janice Tan: And so it's so important for me to continuously see patients and be in the frontline and flex my medical muscle, so to speak, in order to help complement the other roles that I work in as well.
Sharee Johnson: Mm-hmm. So how did all of this start, Janice? Did you know, did you always know you wanted to be a doctor?
Dr Janice Tan: Honestly, no. So what I knew, I knew what I liked, and I liked problem-solving. Mm-hmm. And I [00:09:00] also loved talking to people. Mm-hmm. I was thinking maybe chemical engineering, maybe bio- biomedical engineering. I mean, I watched a TV show as well and also decided things like genetic engineering was maybe the coolest possible job I could ever get in some dystopian fashion.
Dr Janice Tan: And then I went to a university open day, and this was quite late. This was in year 11, and discovered how much maths was involved. And really, we talk about recalibration. That was probably my first recalibration because I, um, I did not like maths. Mm-hmm. And the prospect of having to do four or five more years of maths- Mm-hmm
Dr Janice Tan: um, was a bit scary. So went back to the table, thought about what I loved, problem-solving, talking to people, science, and cool science-y stuff, and really, that sort of naturally pivoted me towards medicine. [00:10:00] Mm-hmm. And so I fell sideways, and I think it turned out to be a good feat, t- uh, a good fit as well. Um, it's interesting, when I went to medical school, I went into, um, one of the top undergraduate medical schools in Australia, which is the University of New South Wales.
Dr Janice Tan: And when you go to one of those kinds of institutions, you find that everyone already has an idea of not just what kind of a doctor they wanna be, but what kind of specialist they wanna be afterwards. And that was really interesting because suddenly I was surrounded by a whole group of really, really smart kids who knew at 18 years old that they wanted to be a neurosurgeon, an orthopedic surgeon, a neurologist, a psychiatrist, a cardiologist, et cetera, as well.
Dr Janice Tan: And that's really interesting as well because, um- I sort of felt like a fish out water because I realized that I knew what I liked, problem-solving, science, and talking to people. But it didn't seem, I didn't quite like an organ. So, um, [00:11:00] eventually I started, you know, pivoting myself again, another period of recalibration into general practice or more, actually more generalist specialties as well.
Dr Janice Tan: So I dabbled a big bit with emergency medicine before I realized that my heart truly belonged in primary care.
Sharee Johnson: And primary care has been under the pump in recent times with funding and just even the profile. How do you feel about that decision of going into primary care? How's it working out for you?
Dr Janice Tan: I think with primary care, you really, it, there has to be a mix of passion and practicality when, especially for doctors when they choose which, um, specialty training they want to go to. And that's because you've got to ... No job would, is 100% perfect. N- you will not love your job 100% of the time, and there will always be not so great moments in your job as well.
Dr Janice Tan: Now the trick here, the practicality part here, is [00:12:00] choosing a specialty or a route in your career that where you have, where you're able to tolerate the not so good parts, and that you can think, think about yourself 10 years from now, if I have a not so good day, will I be okay as well?
Sharee Johnson: Mm-hmm.
Dr Janice Tan: Mm. Passion fuels everything underneath as well.
Dr Janice Tan: You've got to be passionate. You've got to actually care about what you're doing. And really, again, um, you know, there's never, my career's never been a straight path as you can already see. I realized I had a passion for primary care preventative care when I was working in the emergency department. Mm.
Dr Janice Tan: And I saw cases of people coming back, coming back again with preventable conditions- Mm ... that really could have been solved and prevented in primary care as well. And so I sort of saw what happened when primary care didn't work. Mm. Or when primary care wasn't Funded or wasn't prioritized and you could see the consequence of that.
Dr Janice Tan: I treated the [00:13:00] consequence of that in emergency department and that sort of grew my passion, "Hey, if I could fix this before this happened, if I could fix this stroke before the stroke happened, if I could fix the heart attack before it happened, I could s- potentially not just change someone's life, someone's family's life, and someone's community's life, and the population as well."
Dr Janice Tan: . So s- that was where the passion grew. So we talk about primary care and sometimes you're right. In the media, primary care get, gets beaten up quite, uh, a lot of the time as well. Funding from the government is insufficient and proportionately has decreased over the years. We have seen GPs burning out.
Dr Janice Tan: We have seen, you know, um, surveys from things like the RACGP Health of the Nation report, which shows many GPs wanting to give up their careers within five years as well. And I do think there is, um, multiple factors as to why primary care is in the current state as it is right now. But where I see challenges, I also see [00:14:00] opportunities as well.
Dr Janice Tan: Mm. And Sharee, we talk about digital health and where, you know, what role it currently has. I do think digital health is the enabler as well. I do think digital health done well can be an enabler for better primary care, but clinicians also having a longer career in primary care, and lastly, more equitable primary care too.
Sharee Johnson: It's interesting the, the guest who was on the podcast last week, is, Dr. Simon Judkins, who is an emergency physician. You might know Simon. Uh, he's the current Vic AMA president. But Simon, as an emergency physician, was talking about, you know, that prevention is better than a cure, exactly mirroring what you described when you were in the emergency, um, in your rotations.
Sharee Johnson: When you were a registrar as a GP, that's some time ago now, I don't know how long ago that was, but what's changed since then in terms of GP land, in terms of the care with patients and the way that you're able to meet [00:15:00] patients?
Dr Janice Tan: Almost everything, Sharee, which really goes to speak about what an interesting time we're in at the moment.
Dr Janice Tan: I started my early career to GP the moment COVID hit. Mm. And nothing brings the healthcare system to the 21st century more than a, uh, once-in-a-generation pandemic. Mm-hmm. And I rapidly, I've seen everything around the consult change. I was there in the hospitals when they rolled out EMRs and done away with paper notes and paper medications, and everything was all online.
Dr Janice Tan: And then I went into general practice, and suddenly telehealth went from, like, fringe to, like, furniture in the room. Mm. And because of COVID, uh, things came to the rise as well, like electronic prescribing. And in the last few years, you know, uh, I can't work without my AI scribe listening in the room so that, you know
Dr Janice Tan: And that has really changed the dynamic in the consultation room because I'm able to reach [00:16:00] more patients equitably with things like telehealth and being able to send scripts into their phones or referrals straight to their specialist instead of faxing it through. With AI scribes now, even the way, I face my patient is completely different.
Dr Janice Tan: I'm no longer typing on the computer. I'm actually looking at them and having a conversation person to person, which sounds very foreign, but five years ago you had to look at your computer and type as well. I also find that patients have changed too. And again, this is also with the advent of AI and, you know, very easily accessible chatbots which are able to surface, you know, beautiful results to you at, you know, the touch of a, um, a keyboard as well.
Dr Janice Tan: And so I find that patients are also have arriving already researched and very well-informed of their, um, condition or why they might be there. And so my job [00:17:00] then has shifted actually from being the source of information to being the interpreter of it, which I find a better job, honestly. Because really, it's instead of being, practicing that paternalistic, um, version of medicine where there's an information in, um, inequitable information gap between you and the patient, suddenly we are sort of similar in terms of the information we have.
Dr Janice Tan: And instead of, you know, telling them what to do, we're working with them together as co-pilots instead of, um, I don't know, what's the opposite of co-pilots? Just a pilot.
Sharee Johnson: Yeah. I was, I, I was, I was gonna say dictator, but I don't wanna suggest
Dr Janice Tan: that- Oh, no. That, that was in my m- ... our doctors in the past were dictators.
Dr Janice Tan: That was my mind as well. Yes.
Sharee Johnson: Not at all. But collabor- You know, I think you're talking about collaboration and partnership, and so, I'm wondering, I'm, I'm wondering what you, what you might share with the patients. 'Cause there are people who listen to us who aren't, healthcare workers.
Sharee Johnson: [00:18:00] What, what's important for a patient to be thinking about or understanding in terms of when they go to see their GP and they have access to these, this kind of, uh, technology and information?
Dr Janice Tan: Yeah. No, I always say that things that they get from AI chatbots, for example, are really good generalized information, right?
Dr Janice Tan: Like, I think compared to the old, the old days of using Dr. Google where you get 100 search results and you have to filter through them, you get that all nicely quite summarized in, you know, maybe two to three paragraphs as a chatbot response. And my job at the moment, it's really to help guide them through that information now.
Dr Janice Tan: So again, instead of being the sole source of information, I guide them through based on the knowledge I have, not just of their medical condition, but I've been working at my practice for many, many years now, and sometimes I know their story. But, uh, and so also their s- their social and cultural sort of, background as well.
Dr Janice Tan: And sort of that's where I find [00:19:00] myself being at this stage. I also find myself- Helping them work through different priorities as well. So say for example, Sharee someone comes in with diabetes and they've already researched all the different medications to take as well, and all, you know, the, the best practice guidelines.
Dr Janice Tan: Eat lots of fruits and vegetables, low sugar, low GI diet, exercise, et cetera, et cetera. And really they come to me and then we have a chat. You know, they might be of someone from a Chinese background where, like, low GI diets really don't exist in Chinese food, and Chinese food brings families and friends together as well, and you can't just tell, um, someone from a Chinese background not to eat jasmine rice because that's a staple for them.
Dr Janice Tan: And so we work through things like that as well, and we work through things like, "Hey, you know, last time you did try this fad diet. That didn't work." Because we have that knowledge, we have the historical knowledge too. And so that is where I find my job shifting into now, being a [00:20:00] coach somewhat. Mm. But also someone with that, um, medical background as well to be able to guide them through the raft of information they might get from an AI chatbot.
Sharee Johnson: I'm, I'm thinking that the word consultant is actually more appropriate all of a sudden.
Dr Janice Tan: There we go. Yes, absolutely.
Sharee Johnson: And, and also I'm noticing, you know, that, that you, you said earlier, "It's a better job," and I can see that in your face that it's actually... You know, it seems like a better job. It seems more interesting.
Sharee Johnson: It's more connected. What about the, people talk about AI's hallucinations, or what about the misinformation? A lot of people come in with social media kind of information as well.
Dr Janice Tan: Mm-hmm.
Sharee Johnson: How much are you working with helping people still sort out, I know you're saying that it's better than sifting through 20 or 30 Google searches, but there's also mistakes in what people are bringing in, I imagine.
Sharee Johnson: How, how is that for you as the doctor?
Dr Janice Tan: Yeah. No, firstly I want to state that misinformation has existed even before AI. Yeah. So [00:21:00] it's been there with social media, Instagram influencers, uh, Facebook groups as well. WhatsApp groups, you know, that's really big among some of, um, my older generations as well where things get filtered through.
Dr Janice Tan: I think the whole thing with misinformation is really understanding that if they come to you with misinformation and they ask you about the information that they're bringing through- That's already a good sign- Mm ... because it means that they trust you.
Dr Janice Tan: And so my responsibility, my first responsibility, is to make sure that they have a safe space to discuss this misinformation.
Dr Janice Tan: I think the clinicians who looks at something, maybe something that is so obviously wrong, like, you know, the anti-vaccination propaganda, and say, "No, of course not. You're so dumb. Measles, uh, the measles vaccine does not cause autism. You know, that's been debunked." The moment you take that approach with it, that has, that would already just destroy that patient, doctor-patient trust and relationship as well, and that [00:22:00] wouldn't make it a safe space for them.
Dr Janice Tan: Mm. And it means that the next time they come across misinformation, do you think they'll bring it back to that kind of doctor? So really, how you handle misinformation first is creating a safe space because they brought it into the room because they trust you, and really understanding sort of the rationale behind the misinformation as well.
Dr Janice Tan: It could be a trusted, for example, religious person in your community has, has given them... I'm not saying that they do, but you know, it could have come from someone trusted in their community. Mm. Uh, or they could have, you know, prior experiences. So take the measles vaccine, for example. They could actually know a family friend whose kid was diagnosed, um, at three years old with high-level autism, and they were like, "Yes, he did have the MMR vaccine."
Dr Janice Tan: And they could have had that lived experience as well, and really understanding the rationale behind that, too. It's important to provide evidence-based medicine, and that's something I always practice as [00:23:00] well, but there's a way to provide it as well and, you know, really finding that opportunity to say, "I acknowledge that, you know, you may believe in this information," but it's also important to bring forward the evidence that you have from your point of view as well.
Dr Janice Tan: And I find that this approach, you know, we may not see eye to eye and, you know, it's not 100% effective- But it's, we are able to still retain that trust, that, like, clinician relationship as well.
Sharee Johnson: Some of this is music to my ears, Janice, because a lot of the work that I do is around the art of medicine and the relationships and the, you know, there's a lot of compassion in the way that you're thinking about your patients in the stories that you're telling.
Sharee Johnson: Um, but your work also is about strategic. So let's move to this word strategic, because we're talking kind of operational here. What, what do you do with an actual patient right in front of you? This word strategic, what does that mean for you in the way that you're thinking about health, whether that be with the patients [00:24:00] or, or in the digital space?
Sharee Johnson: What's the word strategic important for?
Dr Janice Tan: It's important with strategic as well to think in terms of micro versus macro, so individual factors versus the community versus the population factors as well, but also timelines too. So that's sort of the two approach I take when it comes to things like health strategy or digital health strategy too.
Dr Janice Tan: A lot of my work in strategy or being a strategist or in strategic consultancy work that I do is a translation actually. Mm-hmm. So in, for example, in digital health, the people building the health technology and the people who are using it, the end users, uh, which are often the clinicians, are both brilliant, but they barely speak each other's language.
Dr Janice Tan: And, uh, I've had the fortune of working across very early stage startups, you know, scale-ups, big corporate, government, and investment bodies as well. So I find that I become a [00:25:00] bit of a translator between, moving between those rooms. And, uh, sometimes I do catch myself. Sometimes I get, you know, uh, when I talk to clinicians, I realize, I realize, "Oh my goodness, I'm talking like a corporate person."
Dr Janice Tan: But sometimes I, um, I'm able to translate true clinical need into a corporate sense, into a board paper, into a, a PowerPoint slides, which are very important in corporate. Um, and to be able to tell the story and tell the vision and get the point across as well.
Dr Janice Tan: So I would say, I think what I usually do it's really to be professionally optimistic and also skeptical at the same time as well.
Dr Janice Tan: And I think, you know, that sort of is where I balance, you know, how I work, because I currently work in a very corporate job, um, with the frontline. You know, we talked about this at the beginning of this, uh, recording. Frontline as a GP, because I need to be able to balance both [00:26:00] worlds, but also translate information across both worlds as well.
Sharee Johnson: You're describing learning how there's different language there even the PowerPoints that's making me smile. Was it, was it some kind of dramatic leap, or was it a natural progression for you to start shifting out of the clinical space and working in the corporate space? How did that come about?
Dr Janice Tan: Oh, yeah. No, no, that's a great, that's a great story and a great journey behind it.
Dr Janice Tan: I'm very much a, um, a Fellowship of the Ring sort of, uh, sort of journey, and it's still going as well, hopefully. Uh, look, there wasn't, like, one dramatic resignation letter where I was like, "I quit clinician, uh, clinical work forever." I, I slowly and gradually sort of left full-time clinical work by degrees.
Dr Janice Tan: So I initially started out, um, during the pandemic era, where a lot of health technology startups were being funded, and started doing a bit of health advisory work on the side, so being that strategic health [00:27:00] advisor on the side. Um, and sooner or later, started, uh, collecting, you know, a portfolio of work as a individual consultant.
Dr Janice Tan: And not only was I advising the startup companies, I was, uh, actually starting to do some contracting work with the investment firms investing in those startup companies as well. Um, and then a part-time role at a digital health company, uh, one of Australia's largest, Telstra Health, came out three days a week, and that's when I started cutting down on clinical work.
Dr Janice Tan: When the opportunity at Bupa came out, it was four days of work as well. And so that's when, you know, very, very, very, very patient practice owners I've had, I've been at the same practice the whole time, uh, I then dropped down to one and a half days as well. And to be honest, at the beginning, you know, when I actually cut down my clinical days, it felt uncomfortable.
Dr Janice Tan: And, you know, I think it should be [00:28:00] as well, and because I spent, you know, a good while wondering whether I made the right choice. Medical school for me was six years. Then I did two, uh, two years as a intern and resident, the third year as a, in ED training, and then two more years with general practice as well.
Dr Janice Tan: And so it's like, it felt like a bit of a sunk cost or, like, have I wasted my time if I'm just gonna go work in a corporate job? And I spent a good while wondering whether, you know, um, I made the right choice, you know, whether I was still a real doctor, and whether I wandered too far from everything I've been training from.
Dr Janice Tan: And it was a discomfort that took a while to settle, um, longer than I like to admit. And sometimes I still feel that discomfort as well. But I think, you know, what I would tell my past self as I was making that move is that- I mean, while the corporate workplace, especially with bigger [00:29:00] companies, is like genuinely like a different country, um, different language, different people, different incentives and different rhythms as well, you don't have to become a different person to work there.
Dr Janice Tan: And I think that's when we talk about, you know, again, that career choice is passion and practicality- As long as I hold onto my north star, to my passion, everything around it can flex and I can help design. It helps me design everything around me as well.
Sharee Johnson: I think it's a really exciting time for doctors.
Sharee Johnson: I've coached a number of doctors who are in roles like you, moving across corporate and, and keeping some clinical work. And, you know, to, to me, it's the most exciting time for doctors in terms of the ways that your skills can be applied. Mm. There's never been such a breadth of ways that doctors can apply their skills.
Sharee Johnson: I really appreciate you talking about that discomfort though, because, and this sunk cost. Lots of doctors also talk about the sunk cost, that feeling of, "Oh, but if I turn my back." And really, we don't have to be so black and white. We can have [00:30:00] a really nice portfolio mix, as you're describing. What would you say to a doctor or, or a nurse?
Sharee Johnson: There's lots of nurses who are working in these kind of roles over time as well. What would you say to them about, you know, if they're curious, if they're thinking about applying for these kinds of jobs that are perhaps outside of what they anticipated or what they imagined? What would you say to them?
Dr Janice Tan: I would say no step you take is ever a wrong step. It may feel like a wrong step, as you're taking it or maybe after you take it, but every step you take is an experience, you know? Working first with startups and then with Telstra Health and now with Bupa, every single sort of facet of, you know, that journey has taught me something as well.
Dr Janice Tan: And y- when you look back upon it, you know, year after year, you're like, "Yeah, okay, from this job I learned A, B, C, D, E, and from this job I learned A, B, C, D. And because I did this job, because I did this, I've learned how to be this." And I think when you take that approach with it, you start to [00:31:00] be a bit more courageous as well in taking that leap between maybe clinical to non-clinical work too.
Dr Janice Tan: And of course there'll be that, that discomfort. Like, I can't... You know, I have to almost guarantee that you will feel uncomfortable. But I think we've sort of learned to phrase being uncomfortable and discomfort, right, as bad feelings-
Sharee Johnson: Mm ...
Dr Janice Tan: when it's actually data points to help you, uh, understand how to shape your career around your passion and your north star as well.
Speaker: Mm.
Dr Janice Tan: I do have to say, you know, a bit of a thing of reassurance is that it's not that different. You're right, there's a different language, different culture, different people working there as well, but as doctors, as clinicians, we have a lot of transferable skills. Mm. Taking data points and problem-solving with it, that, those are really, really, uh, strong skills needed in corporate.
Dr Janice Tan: Being able to work in a team, I reflect [00:32:00] as an emergency doctor, I was working with, you know, specialists on the ward, physio, social workers, nurses, pharmacists to, you know, get a patient either discharged or safely admitted. And then I think about my corporate job at the moment where I work with product managers, product designers, uh, legal, governance, uh, risk, et cetera, to get an initiative or a product out to the customers.
Dr Janice Tan: Mm-hmm. So when you think about it, your- that sort of, you know, collaborative teamwork, um, skill, most clinicians already have it as well. Mm. It's just taking those skills and operating it maybe in a different language, in a different country or a different setting as well.
Sharee Johnson: I think it's an identity shift.
Dr Janice Tan: It is.
Sharee Johnson: Yeah. Like, if you can see yourself as something else, if you can imagine learning, because it's not, there's no real failure, as you say. I don't really like the winning and failing language, but you know, there's winning and learning [00:33:00] And so there's kind of, you know, yes, I love this.
Sharee Johnson: This is a great discovery, and there's also, oh, this isn't quite the right fit, and this opportunity has allowed another opportunity or allowed me to see another version of myself.
Dr Janice Tan: Exactly. And I think identity's such a funny, not, not funny, very interesting way to phrase things as well. Because, you know, again, with that discomfort, you know, I was quietly worried that every day that I wasn't practicing as a GP, I was actually diluting the doctor identity as well.
Dr Janice Tan: Mm. But I think now that I'm reflecting on it as you were talking about it, it's actually opposite. I think that the identity got bigger, not thinner.
Sharee Johnson: Yeah, expansive.
Dr Janice Tan: And so-
Sharee Johnson: More expansive.
Dr Janice Tan: Exactly. So I am the GP in the consult room. I am the GP in the product standup. I am the GP in the boardroom.
Dr Janice Tan: You know, just because I'm not wearing a stethoscope doesn't mean that I stop being a GP.
Sharee Johnson: Yeah, that's right. Yeah, I, I mean, that's akin when I'm listening to [00:34:00] you now, that's akin to, when you're a parent, you're still a parent when you're at work even though you're not parenting as such.
Sharee Johnson: You're, you know, focused on something else. And when you're at, home being a parent, you're still a GP. You're still a psychologist. Mm-hmm. You're still whatever you are in your working life. It's, it's similar to that, I think.
Sharee Johnson: Can we go, around to more strategic things, in the clinical space, a lot of doctors are picking up, uh, tools, so transcribing tools and so on. Your thinking, y- your thinking is bigger than that. You think about workflow and patient outcome and, you know, reducing the inefficiencies. Can you talk a little bit to those things that you see happening as, as the tools are being used?
Dr Janice Tan: Yeah. A lot of this has been colored by my experience working in corporate, where I've started taking a bit of a customer-centric view-
Sharee Johnson: Mm-hmm ...
Dr Janice Tan: to patient care. And I know that, that again, makes people, you know, cringe a little bit because how dare we call patients customers?
Dr Janice Tan: But I'm not asking people to call [00:35:00] patient customers. What I'm asking people to do is think about a customer walking into a retail store or a restaurant as well. The people operating those stores, they obsess about the customer experience. Yes, there is the outcome where they buy something or they buy a meal.
Dr Janice Tan: But the experience actually trumps or is just as important as the outcome. I think that is some, that is a view I take when I think about digital health transformation, how AI is gonna transform healthcare, not just for doctor workflows, but practice workflows and even the patient workflow as well. So as it, as it is important for us to think about the patient outcomes, the healthcare outcomes, like we prevented this heart attack, we prevented this stroke, we treated this diabetes, et cetera, it's also important to start thinking about how we're going to optimize for the healthcare experience.
Dr Janice Tan: And again, not just for how the patient [00:36:00] experiences the healthcare in the practice or in the hospital, but also how the clinician or the people working in the general practice or the hospital can experience giving healthcare as well. I think this is a very, very... It's a bird eye view. First, when we talk about micro and macro again - with strategy, and taking this macro view and changing that perspective really does take change about how you think about things as well.
Dr Janice Tan: So let's bring that into the micro sense. When we think about really cool AI tools that are flying out the window at the moment, it's first important to say, "Hey, how is this gonna change the workflow of a doctor delivering care in their consulting room?" If this is going to add more time to it and more burden on the doctor, is this really a tool you want?
Dr Janice Tan: Mm. Or say we have this really cool AI tool that can, you know, um, give the best patient outcomes possible, [00:37:00] but it doesn't really serve their experience. In fact, it could make the patient's healthcare experience worse. These tools are then not things that you would consider as well. Mm. And so that's, uh, that's how I translate, you know, thinking big to thinking small and thinking how things fit, fit into workflows.
Dr Janice Tan: Mm. It's always important to take a bit of a, again, we talk about optimists and skeptical view to things. Mm. I like to take both views because while it is important to be very skeptical about how these tools can change your workflow, it's also important to keep an open mind to things as well. Mm. A funny story, when I first saw AI scribes four years ago, three to four years ago, the first thing that came into my mind was No, not gonna work.
Dr Janice Tan: No one's gonna take it. And four years from now, I'm eating my own words because I can't not use it in my consultation room as well. So there is a, uh, a fine balance you need to take with this too. [00:38:00]
Sharee Johnson: Mm. Are there privacy concerns with the scribes? Are patients concerned about their privacy?
Dr Janice Tan: There... It's interesting.
Dr Janice Tan: So there are, and it's important when it comes to selecting tools like this that some- most of the time a lot of the due diligence fall upon the clinicians selecting those tools, that they have to make sure that their patient's privacy is being held up according to the standards, according to the Privacy Act as well.
Dr Janice Tan: So some AI scribes do send, um, the transcription overseas to, um, overseas models to do the processing because it's cheaper. Mm. Now, that's not actually okay for the Privacy Act as well. And we have guidance from AHPRA and the RACGP about what you need to ask the vendors- Mm ... and those tools as a clinician before you start using them.
Dr Janice Tan: So that's the first step, that the tool selected has to be right. And once you've selected [00:39:00] the right tool and you're confident with the privacy, obligations and governance around it- Mm ... then when the patients do ask you that question, because it does come up from time to time and you do find patients are being a bit more skeptical about AI tools, but also accepting of it as well.
Dr Janice Tan: You have, you're able to give that true and honest reassurance as well. Mm. I ask for consent, as everyone should, before we use an AI scribe in for every consultation. So Sharee doesn't matter whether you come in today or in two weeks' time, I do have to ask you for consent at every instance as well. And surprisingly, what I'm finding is that when you give them that reassurance about privacy, privacy, the true reassurance- Um, a lot of them are quite reassured by it, and they're happy for it to be used as well during the consultation.
Dr Janice Tan: I very rarely get any, um, rejections as well. Mm. But then again, you've gotta get... You know, we talk about safe spaces. You have to make sure there is a safe space for them to decline, and they don't feel pressured to say yes as well. So I have notices, you know, before they come into my consulting room to warn them, and I check with them [00:40:00] again.
Dr Janice Tan: You always have to give them that reassurance that, you know, "Sharee even if you say no, Janice, I don't wanna use your... I want, don't want you to use the AI scribe, that that's not, not going to, uh, change how I'm going to treat you ."
Sharee Johnson: The governance is interesting too, isn't it? Because it's hard for governance to keep up with the pace of change that's happening.
Sharee Johnson: I know I was in some talks a couple of years ago where, uh, doctors were saying to their, um, uh, medical defense, "Why do we have to do the due diligence? Why do we have to reinvent the wheel over and over and over?" Every single individual doctor trying to do the due diligence of these tools, um, and the medical defense organizations being reluctant to make any advice and then, you know, 12 months later making that advice because, uh, you know, because it was so prevalent, everybody was needing the same advice and, and so- Mm
Sharee Johnson: that, that shifted quite a lot. So I think this challenge for government and colleges and AHPRA and so on, regulators, to maintain the governance at the pace we need it is, is difficult. [00:41:00]
Dr Janice Tan: And this is a brand new world for many regulators, clinicians- Mm ... patients alike as well, government too. Mm. And we're starting to find that, um, traditional tech governance and regulation standards can't quite keep up with it.
Dr Janice Tan: Because when you think about the pace of change for non-AI technology, it would've been three, every three to four years, and that would give people and regulators enough time to do consultations and whatnot. But with AI, things are moving so fast. Mm. Uh, what I thought I knew about AI six months ago, I...
Dr Janice Tan: It's probably outdated at the moment.
Speaker: Mm.
Dr Janice Tan: Uh, and I think that is where the challenge is for us. I don't think it falls primarily on the regulators, but us as a civilization as well- Mm ... to think about how we are going to regulate this as a [00:42:00] society as well, and whether this can be regulated in the traditional sense or whether we need to take a more principled approach to regulation as well.
Speaker: Mm.
Dr Janice Tan: It's a brand new world for a lot of us, but it's also a little bit genuinely exciting as well to see how, uh, anthropologically society is changing and how we need to adapt to these things as well.
Sharee Johnson: Yeah. Big conversations. I think they're really, we just need lots and lots of conversations. Can we, can we turn our attention to My Health Record?
Dr Janice Tan: Yes.
Sharee Johnson: How, how is that going for you, uh, from any of the angles that you're looking at it? I, uh, the first question is, who owns the data from your understanding?
Dr Janice Tan: From my point of view, it's always the patient. Mm-hmm. So it's their record, they control access, and, you know, patients can choose to restrict or remove documents from My Health Record as well.
Dr Janice Tan: And- Custodianship, I think sits with the government, and the accuracy sits with whoever authored the documents, so ap- maybe the clinician as well. Mm-hmm. So if I as the doctor upload something [00:43:00] to a shared health summary, um, I'm accountable for it being right as well.
Speaker: Mm-hmm.
Dr Janice Tan: A timely question too that you brought it up because sharing by default went live on the 1st of July.
Dr Janice Tan: Mm. So that means pathology and imaging reports now have to be uploaded to My Health Record unless there's, like, several exceptions to that. But that's the biggest structural shift as well, because most routine pathology now is, uh, or, like, radiology results becomes visible to patients as soon as it's uploaded.
Dr Janice Tan: Mm. And, and, you know, in the past, you know, you would be only be able to access those records when you go back to, like, the referring GP. Mm. And sometimes, you know, you know, things get lost in the whole, uh, ecosystem of healthcare in Australia. You know, sometimes you cannot, you, you lose results here and there.
Dr Janice Tan: Things get faxed around. Things don't get sent through. This really is a genuinely- interesting step change in things because not only can I now [00:44:00] easily access results, uh, regardless of who ordered it on the patient's My Health Record, so can the patients. Mm-hmm. And I don't think that's necessarily a bad thing because as you heard from earlier in this conversation, um- I genuinely think that the more well-informed the patient is, the better we can work together to achieve the best healthcare outcomes for them.
Sharee Johnson: Yeah. There, there was some talk, I don't actually know what happened, but there was some talk about creating barriers for some kinds of results for patients to s- not be able to see some, some more, uh, you know, potent or frightening results without being present with the doctor. Is there any barrier at the moment for any of that, is it your understanding?
Dr Janice Tan: There are a few exceptions for very specific genetic test results, for example. Mm-hmm. But I think, you know, it's important to understand the impact versus intent of doing something like this, because someone could say, [00:45:00] "Oh, HIV results." You know? Mm-hmm. For example. Patient shouldn't see that. But is that taking agency away from the consumer? Mm-hmm. And I think that is interesting as well. It becomes a bit of an ethical, uh, debate. Yeah. And you're right, we should keep talking about it, you know, things like this. Um, but at the end of the day, we go back to who owns the data. Mm-hmm. And it's the patient as well.
Sharee Johnson: I think there's, there's a lot of ethical and agency questions. You're pointing to them, um, beautifully. I think one of the things is about interpretation, the translation role that you were talking about earlier. Mm-hmm. That if, uh, often, a, a, a medical report doesn't make a lot of sense to a lay person.
Sharee Johnson: Have you, have you any experiences of this since the 1st of July with your patients?
Dr Janice Tan: We... I have, actually. It was actually before the 1st of July. I think my patient was able to access their MRI report on My Health Record before they came to me, and if, uh, you've ever read an MRI report, you know that's the biggest, like, um, medical jargon report ever. But, um, they actually put it through [00:46:00] ChatGPT, rightfully or wrongfully. And ChatGPT actually spat out a beautiful
Dr Janice Tan: A beautiful, um, non-medical jargon version of it. Patient was able to understand it, understand what a meniscus was, understand what meni- meniscal tear was, understand the treatment options for it, and when they came into my consulting room, we were able to work out the best way t- for them to return to running so that they could run the Sydney Marathon.
Dr Janice Tan: That just happened a few weeks ago. That's fantastic. Weeks ago. So, like, this is, you know, there is, like, fear that, you know, they may not be able to, um, interpret what's in the report, or they might get scared of it, but I do think that we also forget that patients are n- now more well-enabled with AI, and I think that is an opportunity there as well.
Sharee Johnson: Mm-hmm.
Dr Janice Tan: Um, it does change, though, how I, you know, talk to patients when I order things as well. So for example, if I order a blood test, now I say, "Hey, we're sharing by default. This blood test will come onto your My Health Record in seven days. You [00:47:00] might see it before you come and see me. But really, let's to close the loop, guys, and let's-" Just come back and see me if you want to.
Dr Janice Tan: And again, you give them, you open that door, because we can work together what's the best way forward for you. Mm-hmm. And I would say 80% of the time they do come back regardless of whether they have access to My Health Record or not. Mm-hmm. So really creating that opportunity, creating that safe space for them- Mm-hmm
Dr Janice Tan: to come back and talk to you. I don't think this is gonna reduce my patient load in any sense. , I'm still booked out two weeks in advance. Um, but I do think that, patients when they come in now, we can have a better... We can use that 15 minutes to have a deeper conversation.
Sharee Johnson: Mm-hmm. Mm-hmm. I, I hope that's true because it's so brief for a lot of people, isn't it? These consultations, they're so short, and, and I can see for a knee and so on, that would be fabulous. I'm wondering about the diabolical diagnoses, you know, p- people who are being diagnosed with cancer or MS or, you know, the, the things that they might jump to conclusions about without, uh, a [00:48:00] person beside them interpreting it or helping them understand it.
Dr Janice Tan: And I think that's interesting. So there are exceptions to those rules. So some of those diagnoses may fall into that as well. Things like, you know, like really specific genetic con- uh, conditions. Um, and I do think, you know, there, there has to be workflow changes around any tech advances, um, uh, that happens, and sharing that by default will be one.
Dr Janice Tan: And the thing is, is sharing by default pathology and imaging reports, that's just the first step. Mm. What's gonna happen afterwards? Specialist reports, discharge summaries- Mm ... et cetera. And I do... There are downsides to everything, but I do think overall, it's a, it's a very positive step. Mm. More patients become more empowered.
Sharee Johnson: Yeah. And there's certainly appeal for that in terms of empowered patients. Also, personalized medicine, preventative medicine in terms of getting in front of things. You know, there's a lot of appeal. I can see that. , When we're thinking about innovation and [00:49:00] emergent, uh, things, what's, what's on your radar that you might, want us to know about?
Sharee Johnson: What's exciting and what's happening in the future? She with the crystal ball!
Dr Janice Tan: Yeah. No, I would say in the next five years we're going to get a bit of a shift of how genomics is being used in ordinary general practice. And it's really, it's a really nice full circle moment, 'cause remember when I was a, um, year 11 student, I was really interested in genetic engineering- Yeah.
Dr Janice Tan: Mm ... from this TV show I watched. Um, and, and so it's really interesting to see that technology becoming more accessible. So things like pharmacogenomics, right? Uh, which is basically tells you how your, uh, how your own personal DNA can change how you respond to certain medications. When I first learned about it, it was $2,000 to access.
Dr Janice Tan: Now you can access it for $150 for that same test, which probably tests even for more medications as well. And that's, it's becoming more accessible for patients, and there is [00:50:00] evolving governance around it to make sure that things can't be used to discriminate you. So a really exciting legislation that got passed in Parliament, um, a few months ago, was to prevent and restrict life insurance from discriminating against you based on your genetic testing results as well.
Dr Janice Tan: Mm. And I think when you have that governance and safety around it, people are more likely to take on genomic testing, especially as the technology becomes cheaper and the testing becomes more accessible. Mm. So that means that, you know- My Southwestern Sydney patients are then able to get very personalized prevention, um, advice based on those genomics results as well.
Dr Janice Tan: Mm. So really, um, that is something that we are, um, very much excited and I think will change how we practice in primary care and preventative health over the next five years. Mm. I mean, that's always AI as well, and I do find that, you know, we talked about, um, doctors and GPs burning out and GPs wanting to leave [00:51:00] the profession.
Dr Janice Tan: I genui- genuinely would like to see how, you know, AI scribes could maybe h- change that as well. Not just from a workflow productivity perspective, but also, like, a well, clinician wellbeing perspective as well. Because that means that I get to go home in time for dinner, in time for daycare pickup. Mm.
Dr Janice Tan: Maybe even have a cup of tea between my patients as well.
Sharee Johnson: Yeah. But also that in, in the, the meaningfulness, the fulfillment, the satisfaction measures. You know, that's... Why, why do people come into medicine? A whole range of reasons. One of the consistent ones is that they want to help, or because they care, or because they want to make a difference.
Sharee Johnson: Uh, and I think this feeling of I actually could look at my patients and talk to my patients and feel like-
Dr Janice Tan: Mm-hmm ...
Sharee Johnson: very hard to measure, but feel like we collaborated, or we were in partnership, or we solved a really tricky problem together. That's sustaining for doctors. We know that that helps all healthcare professionals stay in their work when they have that feeling more often.
Dr Janice Tan: Absolutely.
Sharee Johnson: [00:52:00] Mm. So, um, we're coming to the end of our time, Janice. I wonder what you can tell us about what sustains you. What are the things... We've heard some of the things already, but what are the things that help you stay in this complex work that's keeping you very busy, that's got, you know, some problems that don't have easy answers, lots of problems that don't have easy answers, strategic and operational.
Sharee Johnson: What keeps you in the work?
Dr Janice Tan: Non-negotiably, family.
Dr Janice Tan: Family and friends and the people around me. Uh, my parents are aging, so I'm constantly thinking about what sort of healthcare system I want them to experience. I have a two-year-old. I'm also constantly thinking about what kind of primary care she'll be able to access in two or three decades time as someone who's then my age, right?
Dr Janice Tan: And so we ta- again, we talk about passion and practicality, and that passion is the North Star that's underneath everything I do, which is to really [00:53:00] leave the world the better place, um, a bit better than I found it. Um, I do think we're on this face of the earth for such a short amount of time, and I think, you know, the m- what, I want to make the best use of it, uh, and leave, again, a better world for the generations to come as well.
Dr Janice Tan: And I think in the most challenging and the worst weeks I've had, I think that's what reorients me as well.
Sharee Johnson: And, and who are your sounding boards? Obviously, family is, even if it's just in your own mind. Who, who else? Not necessarily the names of the people, but how do you keep a, your own perspective or your own peer, sense?
Dr Janice Tan: Absolutely. I'm very fortunate to have found a bit of my tribe in terms of other doctors who have embarked on creative careers as well. And we do have a very supportive group with doctors from all over Australia, um, where, who are innovating in very exciting ways. And these are, you know, again, very useful sound boards.
Dr Janice Tan: I do have certain people I have on speed dial to [00:54:00] call if needed as well during challenging times, and I think that's, I think that's probably so important in this journey to know that you're not alone and you're not the only one doing things as well, and that there are other doctors going through the same journey, maybe some further ahead or maybe some walking alongside you or some that you can continue opening the door and guiding too as well.
Sharee Johnson: Yeah, it's so essential. Is there anything, Janice, in our conversation today that you feel like you'd like to put a pin in or go back to? Any- anything that you think we missed?
Dr Janice Tan: No, I think this was really good. Thank you, Sharee. I really enjoyed this.
Sharee Johnson: You're very, very welcome. Thank you so much for your time and, uh, I'm reassured that the doctors who are thinking about, digital health are also, if you're representative, also really thinking about the patients and their colleagues with this level of compassion.
Sharee Johnson: I, I wish you well and thank you for all the work that you're doing on our behalf.
Dr Janice Tan: Thank you, Sharee.
[00:55:00]
