Bitesized Dr Eric Levi – The human side of working as a surgeon
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Dr Eric Levi: don't think I'll be where I am if it wasn't because of all the sacrifices that my wife has made as well. So yeah, we've got three kids now. One is in year 12, year eight grade six. My year 12 boy wants to do medicine as well, I, ... Regrets in life.
Dr Eric Levi: So one of my biggest regrets ... so like I started the journey towards surgery when he was born. So like I said, I've been a [00:01:00] doctor for 21 years now, so I started my surgical training basically when he was born. And I always have at the back of my mind, I just need to get through surgical training so I can spend more time with him. And then I just need to get through the exams so I can have more time with him. So I need to get through my fellowship so I can have more time with him. I need to set up my private practice and get established in Melbourne so that my life is safe and secure so I can have more time with him, and the next thing you know, he's in year 12, and next year he probably doesn't even want to be with me anymore.
Dr Eric Levi: He's probably gonna do medicine somewhere in another state. I don't know. But that, that, that was a real, regret. I had breakfast with him just a few months ago and I openly said, "I am sorry. I, as a father, that's one of my biggest regrets is not having enough time to spend with you because you, you're
Dr Eric Levi: I started surgical training when you were zero, when you were one. And ~that, ~that, that has been the kind of, [00:02:00] always at the back of my mind, could I have done things differently? Could I have done things better? Have I spent, too much time in surgery? Because there is a minimum duty requirement in, it's, I can't just operate on a patient and just say, "No, I'm not gonna be on call for you."
Dr Eric Levi: Yeah, so that, that's a real balance as well. And the other thing as well, unfortunately, I've chosen the life to do quite a lot of public work. Some of my colleagues probably spend 80% of their time maybe in the private, and only 20% in the public. I'm almost the reverse. I'm spending 75% of my time in the public with the commitments of being part of leadership, teaching, education, and all those things.
Dr Eric Levi: These are the things that I do enjoy, and that's why I love the teaching, I love the operating, I love the engagement with trainees. But at the same time, it is costly, from a time and emotional and cognitive point of view as well. I don't know that I have the, easy answer.
Dr Eric Levi: Maybe I should be your the example of what not to do, Sharee You know?
Sharee Johnson: I'm not sure about that, Eric, what I'm [00:03:00] really noticing is the reality of this. That we're not- Yeah ... trying to paint a here's the perfect picture or here's the- Yeah ... recipe, 'cause there isn't one. Yeah.
Sharee Johnson: The benefits, we can make arguments for any of the sides we want, can't we? You know- Yeah ... the benefit of you doing work that's fulfilling and- Yeah ... challenging and that you enjoy- Yeah ... means that you come home in a certain state- Yeah ... to, to if you were doing something you didn't like.
Sharee Johnson: What I do hope the listeners are listening to is that there is a choice in this, and that we are responsible for our choices. Whether we regret them or not- Yeah ... there is a element of being responsible for our choices.
Sharee Johnson: A lot of, early consultants come to coaching saying, that they don't know what to do 'cause they're not on the, they're not on the prescribed track anymore,
Dr Eric Levi: Yes. Exactly.
Sharee Johnson: So I think this time of trying to work out, will we have children, won't we have children, will we move interstate, won't we move interstate, how much of a commute can I tolerate, 'cause that's- Yeah ... more time away from my family. All of these things- Yeah ... are real, day-to-day- Yes- dilemmas that people are grappling with.
Sharee Johnson: And for any audience that's listening that's not a healthcare worker, and particularly not a doctor, I think there's so much [00:04:00] unseen work that doctors do- Yeah ... that we don't appreciate. We just as members of the community think, oh, well- Yeah ... when the doctor's not with the patient, they must be at home with their family, and of course- Yeah
Sharee Johnson: that's not the reality. That's true. Yeah. Yeah. The other thing that you're pointing to is the variety in your work. That going to the public, being part of the public institution- ... gives you more variety in terms of leadership and teaching and so on. And I think that's something that is of value as well.
Dr Eric Levi: Yes. You, I think you beautifully summarized that. When I told my son "Are you sure? Haven't you seen how Mommy and Daddy work? I do 60-hour weeks. My weekends, are, c- caught up operating once in every three weekends. We don't do too many, weekend or evening things, and stuff like that because I've got meetings in, two out of three, two out of five evenings on a weekday," and all those thing.
Dr Eric Levi: And he just said, "But you seem to love what you do, and your job seems really interesting and exciting." And that was what drew him to medicine or [00:05:00] surgery in particular. But you're right. The various different varieties, you've nicely put it all together by saying that these are the little passions that I like or that I enjoy that at least gives me a sense of purpose or give me a sense of pleasure.
Dr Eric Levi: There's always that question about, joy in work, seeking the joy in work. I find that, for me anyway, speaking personally, joy is the secondary side effects of purpose. What I mean by that is what I'm looking for is not I don't necessarily come to work wanting to be happy. I want to be useful.
Dr Eric Levi: And when I feel that I'm being useful, that's when I get the joy, as a secondary aftereffect of knowing that my work matters and that is purposeful and impactful,
Dr Eric Levi: yeah.
Sharee Johnson: So beautiful, Eric. We wish that for everybody, right? Yeah. That they can have something purposeful to do in their day.
Sharee Johnson: Yes. And that out of that comes, these other things like joy.
Dr Eric Levi: Yes. Yes. That's right.
Sharee Johnson: You post on social media, and I wanna talk to you about that in a little bit. But, one of the things you sometimes post about is getting the coffee for the [00:06:00] team. Yeah. And so I wonder if you'd just say a little bit about your ideas about leadership or about teamwork.
Sharee Johnson: Yeah. Wh- whatever angle you wanna come in there. Yeah. It seems, it is a part of this joy element, I think. Yeah.
Dr Eric Levi: It's the love language, isn't it? Like I come to work ... And it's very interesting because every single day I would be working in potentially different locations with different teams in the operating theater.
Dr Eric Levi: And a lot of studies, you're a psychologist so you know the studies that, that the culture of the team matters, you know? And to me, the simplest way that I can influence culture is just by, being kind. And so that kindness in medicine and surgery is really coffee, chats, conversations.
Dr Eric Levi: The intensity of the work, that isn't reduced. We still look after really sick patients. But when you have built that little, coffee conversations, little jokes here and there, things that break the ice. [00:07:00] Then during those times when high-intensity work needs to happen rapidly, then you've already created culture that creates the foundational thing, or the relationship.
Dr Eric Levi: So to me that ... I don't know, that comes naturally to me because I always think about that maybe. But it seems to me that it doesn't always happen everywhere. I tell some of my students, "You're always welcome in every operating theater. But before you go in, just peek into the room and just have a look at the expressions of the team members.
Dr Eric Levi: If you see a lot of really stressed out nurses in a corner, that's probably not a good learning experience for you because that's a potentially an unsafe working environment in that there's a lot of tension, there's a lot of communication issues maybe. If you want to step into, an operating theater, see if you can find one where there's a little bit more relaxed body language."
Dr Eric Levi: "And that's probably where you'll probably learn the most." So I give this little warning. But I'm sure if you're an observer for teams, that's something that you might see as well. Teams with very strong hierarchical structures might be [00:08:00] more rigid and intense. Teams that are perhaps more psychologically safe probably have a lot more natural body language that are a bit more comfortable.
Dr Eric Levi: Do you have anything to say about that yourself, Sharee?
Sharee Johnson: Oh, yeah. I think you're pointing to a couple of really important things, Eric. One is that we know that we learn when we're relaxed. Yeah. When we're stressed out, we're worried about survival and staying safe. We can't actually take in and remember things- Yes
Sharee Johnson: very satisfactorily in that condition. So- Yeah ... absolutely I support that. The other thing that you're, pointing to I think is that, the research around trust says that- Yeah ... it's really about competence first and relationship second. So- ... wh- when you meet somebody new, but in- ... in the theater if you're working-
Sharee Johnson: with somebody you haven't worked with before- ... you want to know something about their level of competence. You want to know how much support they need or how many instructions you need to give them- so once you have an assessment of their level of competence- Yeah ... it really comes to relationship.
Sharee Johnson: And if you think- Yes ... of people you know well, who you've had long relationships with, you give them the benefit of the doubt. If something goes wrong- Yeah ... you give them the benefit of the doubt. Yeah. Because you've got [00:09:00] established trust through relationship. Yeah. Yeah. But at the beginning of a interaction where you don't know the person, it's more about competence because- Yes, true
Sharee Johnson: And what you're describing is these building of relationships- ... that allows, trust to build. And, so you still need competence- Yeah ... but because you've known their name or because you've- Yeah ... because people feel- Yeah ... because people feel - Yeah. That's right ... seen and heard- Yeah And this act of saying, "What kind of coffee do you want?"
Sharee Johnson: Or, "I brought you a coffee." Yeah. Or, "Does anybody else- Yeah ... want a coffee?" Yeah. That's an act of I see you. Yeah. I want to know about you, or I want to do something to- Yeah ... connect with you. Yeah. The Gottmans would say that's an act of looking for connection.
Dr Eric Levi: Yes. Yes.
Sharee Johnson: These are really important things in trust, and they- Yes and the other thing you're pointing to is that it takes ... It's momentary. It- Yes ... can sometimes take just a few seconds. Yes. But the value of the person feeling seen and heard means that now they trust you. They think- Yeah ... oh, he saw me. Yeah. They want to trust you. Yeah. And they just need to know you're competent, but they're already [00:10:00] ready to give you- Yes
Sharee Johnson: benefit of the doubt because they've- ... connected and built some sort of fledgling- Yeah ... relationship with you. Yeah. Yeah. It's powerful stuff.
Sharee Johnson: I have a favorite thing of saying that the art of medicine enables the science, and I think that's the territory- True ... that we're in, that, that- That's true
Sharee Johnson: you can have all the magic of modern medicine- Yeah ... but if we can't get the other person, our team member's attention, or if they won't speak to us- Yeah ... you know- Yeah. Yeah ... then we may not be able to deliver the magic that the technology allows.
Dr Eric Levi: Yep. No, that's very true indeed. I've seen that again and again in teams. And maybe this is just because all through my training as well I've chosen role models that actually embodies that as well. I've seen enough, I know enough, people with long titles over their names- ... that probably are a very different person in clinic or in the operating theater.
Dr Eric Levi: And I've seen others who are effective leaders with no fancy titles, but really is a master at getting the team together and getting good results for their patients. The academic titles versus the day-to-day [00:11:00] practice, they're two very different things sometimes. And I guess, I've always wanted to model myself, following the model of those people who really empower their team.
Dr Eric Levi: And just nice to work with. Nice to work with. Yeah. Brings a lot of, comfort to, to, to me even as a junior in their team.
Sharee Johnson: Yeah. You used the word power earlier, and now you're talking about empowerment, and even just to notice these things and name them has an impact. When people, if people have an idea that their colleague is interested in empowering other people- Yeah ... then they respond differently. And we lose our voice. We had Victoria Lister on the podcast a few sessions ago. She studies, how people have their voice or, or- become silent at work. And, the numbers are pretty frightening. It doesn't take- Yeah ... very many times for people to stop saying something about patient safety- ... or about, the bullying that's happening or the other- Yeah ... things that might be happening between colleagues. So having people around who will name things, I want you to feel empowered enough to speak up- yeah ... if you see something. Yeah. That has a big impact.
Dr Eric Levi: Yes. [00:12:00] Yes.
Sharee Johnson: We've talked a lot about your identity. We've talked a little bit about your identity as a dad. We've talked about you- Yeah as a surgeon and as a student and so on. You have this social media profile that sometimes you're quite active on and sometimes you go quiet for a while. Yes. I think I've learned things like you used to have a rabbit at home, and we have a rabbit here. So I noticed that and, and- Yeah and your coffee. Yeah. And you posted a couple of things recently. You've posted about the hours and the years of study- Yeah ... that you've done. But you posted a very graphic image recently, a couple of things, one with blood all over your face. I think that was at Christmas last time when you-
Sharee Johnson: ... Had been in surgery. And another one where there was some reconstructive surgery. I can't remember what the case was. You showed the number of people in the room. That ~the, ~the pre-team and the post-team, if you like. Yeah. What's your hope or intention when you're showing those real-life images of, of- your work? Mm. Mm. What do you hope people learn when they see those?
Dr Eric Levi: I guess the humanity of it all. What I mean by that is, people might think that the surgeon always leave unscathed, we actually carry our battle scars. What a lot of [00:13:00] people don't realize is, people say, oh, that doctors change lives and things like that.
Dr Eric Levi: The reverse also happens. Patients actually change lives. Patients change our lives, or patients affect us, or we carry a lot of our patients. And are both the good and the not so good. What I mean by that is, when you see one of my youngest patients who had cancer is a, five kilogram, three-month-old.
Dr Eric Levi: And that patient will stay with me for a very long time. He's alive. He's well. This was about seven years ago. But to walk with a new parent, talking about their child having cancer and being treated for that, it's a massive thing. That's on one hand.
Dr Eric Levi: On the other hand, when I've got the 80, 90-year-olds with malignancies of the tongue or the face, that's another different discussion as well in that, in, in their different context. But what I really wanted to show was just the humanity of it all, that we do carry our patients home.
Dr Eric Levi: We do feel for our patients. They are more than just- [00:14:00] cases or tasks or jobs to be done. And it does affect us as well, and I think maybe a lot of people don't realize how much a lot of surgeons actually do think about their patients and carry them home, and maybe that's just, that's all.
Dr Eric Levi: Maybe this is also an expression because, I happen to be on social media, and I happen to be quite honest with my sharing of busy life, the sacrifices. And that's not to get a pity from people, but it's actually just to show the reality of it all. That the work, takes a lot from us.
Sharee Johnson: ~Mm. ~Yes, it does. I wanna come back there again too, but, before we do that, I, there's a bit of a push right now for, more doctors to be on social media to counter these, non-doctors, non-clinicians who- ... let's say, propagate s- a lot of misinformation. Let's say it like that.
Sharee Johnson: Yeah. Yeah. What's your advice to other doctors who might- ... contemplating, maybe I could be on social media- Yes ... but who feel very wary about the, the regulation, the regulatory rules around it- Yeah. Yeah ... those kinds of things. Yeah. Yeah. What have you [00:15:00] learned? What advice might you offer in that-
Dr Eric Levi: Yeah, interesting. I've been on social media since I started my surgical training. I was under anonymous because I wanted to try and explore different things, first of all. I think social media is a medium. It really is just a medium. You can use it for good, you can use it for bad. I think there was a recent, quote that says, "Why are doctors now becoming influencers?"
Sharee Johnson: Yes, I saw that.
Dr Eric Levi: Because in- and because influencers are becoming doctors now, so in a sense, all that we're doing is putting on social media what we repeatedly do on a day-to-day basis, and for me, that's just education. I don't put social... I don't put stuff on social media so that people can see me in my private clinic.
Dr Eric Levi: In fact, most of my followers and other things are probably not even in Australia. I put social media really as an educational platform to share, basic, simple, ENT, ear, nose, and throat related, stuff, life of a surgeon, and also just being a human being, being a dad, with a life outside of the operating theater.
Dr Eric Levi: And my [00:16:00] encouragement for anyone, any clinicians, doctors, nurses, allied health, is to say, you're a professional, at work. You can be the same professional on social media. You can tweet about or share about what you do. Now, you don't talk about patients, but you can talk about- conditions.
Dr Eric Levi: So that's my simple line. Don't talk about patients, talk about conditions. You can talk about what you do. You don't have to say that you're the best at doing this. You just share what you do. And that's not to draw attention to you, but that's again, to really just put some neutral information that is helpful for the public to engage with.
Dr Eric Levi: There are some clear guidelines in Australia. But basically you can say what you do. You just cannot say that you're the best at doing it. You cannot promote unnecessary services, meaning you can't say, "If I take your right tonsil, I'll s- do your left tonsil for free." You can't do any of that.
Dr Eric Levi: You can't put any patient, testimonials. Those are some general rules. So my guideline is basically simple. Talk about [00:17:00] conditions, talk about what you do, ~educate, ~educate. And stay professional. , being a professional at work, being a professional at social media will be helpful for a lot of people, I think.
Sharee Johnson: ~I, ~I really appreciate seeing you there. I think you've, you obviously doing, have been doing it for a long time. Yeah. And I think there's a handful of doctors in Australia really showing us very beautifully how you can educate- Yeah ... in the way you've just described. Yeah. But, before, before we went there, we were t- you were also talking about the impact of being a surgeon, how that affects you.
Sharee Johnson: And you've done some talking in the world about, about that, about the wellbeing of surgeons. Yeah. Can you share with us some of, the key messages are, what you think people, other surgeons in particular, might benefit from that?
Dr Eric Levi: Yeah. Yeah. You mentioned very briefly in the past, d- during recalibration. So I had my burnout period, I really burnt out, actually not through training. But after training. So after I finished my fellowship, I got really burnt out. And that I think is partly because during training, I always had something to look forward to. I had to finish my exams, to finish my fellowship, [00:18:00] finish this, this and that.
Dr Eric Levi: And then after you finished everything, you're "Okay, so what's next?" And, I think that point of recalibration also was a point of, okay, I was really burnt out at that time. And I still remember very vividly one, news where, I'm sorry about this is a trigger warning, but there was , a gastroenterologist in Brisbane who completed suicide.
Dr Eric Levi: And his wife actually wrote a very, a powerful moving letter about how, work really affected him. Some patient complications and other things really affected him. And I know, a couple of other clinicians who have passed away as well in the context of work related kind of stresses.
Dr Eric Levi: So I came to that season of life realizing that I could be the best trained surgeon in the world, but if I don't look after my own soul and heart and humanity, I may not be alive in, in a few years, so I had to face my own [00:19:00] mortality and I think that's when I started talking about what are the things that we have lost as a surgeon?
Dr Eric Levi: We've lost our sense of autonomy sometimes. Our work-life balance is taken away from us because we are a slave to our pager sometimes. We've lost a sense of community, the life of a clinician, Again, I can only speak for myself. The life of a surgeon can get pretty lonely, because even though I'm surrounded by registrars, trainees, and other things, at the end of the day, the patient is still mine, and every complication that happens or every poor outcome that happens, I do take it on to a certain degree personally,
Dr Eric Levi: So those were some of the dark moments, the autonomy, the lack of community as well, a- and the repetition of routine that gets taken away from us. And so some of the things that I encourage my colleagues to do is to return to some of that, get some autonomy over your life or your career.
Dr Eric Levi: If there are sections of your work where you find the least, , where you're [00:20:00] le- least autonomous or you're unable to make decisions, maybe those are the things that are eating away at your soul. Are you able to find other parts of your career or your life where you can feel more autonomous, have a bit more autonomy?
Dr Eric Levi: The other thing is forming communities, have a group of colleagues, and they don't have to be medical colleagues, they don't have to be another surgeon or another clinician. They can be people from your faith communities, from your so- your sport communities and all of those things.
Dr Eric Levi: Just building, around that. Those are probably some of the simple things, and it probably is so common sense, to you and to many people, but I guess it's just something that just needs to be mentioned again and again, , that the pressure of clinical work, the pressure of, patient expectations, weighs heavy on us, and so we need to find a way to, to resolve that balance with autonomy, joy, meaning, purpose, community.
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