Ep 29 - Dr Rhea Liang
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[00:00:00]
Sharee Johnson: In this really interesting conversation with Dr. Rhea Liang, breast surgeon, general surgeon, uh, Dean of medical curriculum at Bond University. Significant contributor to the Operating With Respect program at RACS, Rhea and I inquire into this question about merit. How do people get into medical school and [00:01:00] specialist training based on merit?
Sharee Johnson: What does that really mean? And are there biases? And we don't use that word actually in this conversation, but certainly it raises the question of what kind of merit are we valuing? And there's a very deep concern, I think, in Australia, that there are no female indigenous surgeons. I think we want to look at that very closely.
Sharee Johnson: And Rhea did tell me about something very interesting, Te Rau Poka, uh, in New Zealand, that is an organization, the Māori Surgical Academy, that is sponsoring, mentoring, helping secondary school students to think about surgery and working with those students all the way through as, as support and, and mentors until they're well into their surgical training.
Sharee Johnson: And as a result, there are twenty-eight Māori surgeons practicing in New Zealand. Right now, [00:02:00] there are very few Aboriginal surgeons in Australia, and they're all male. So there's some important work for us to do, and we touch on that a little bit in this conversation. So we talk generally about the selection of medical students into, into medical schools and training.
Sharee Johnson: We talk about the change in curriculum that's happening, that, doctors are needing to be taught as much, at least, and perhaps more, about skills than about knowledge. That there is a core, knowledge set of curriculum that our doctors need to have. The pace of learning and knowledge is so rapid that the half-life of medicine now is something like a month or two rather than years.
Sharee Johnson: , So thinking about how do we teach the skills to our medical trainees that they need to decipher and discern what's Rheal and what's a hallucination, um, and, and what information do they still need to have as core knowledge as doctors?
Sharee Johnson: I thought it was a really interesting part of the [00:03:00] conversation where I asked Rhea about whether she enjoys being on all the various committees and, and policy and change-making, um, projects that she's on. And she said what she really enjoys is when she's working with people who, uh, can change their mind.
Sharee Johnson: I think that's really interesting for all of us, too. So she named three things. She said people who are effective Uh, changing policy and making decisions in committees, have trust, so there is a relationship. They also have a, genuine willingness to engage in the dialogue, so to test ideas and to say, "Is this the right policy?
Sharee Johnson: What do we think about this policy?" And an ability, a capacity to adjust and change their mind. Rhea said that there are some people that she trusts very much, and she knows she's not going to change their mind. I think is really an interesting distinction about working with people who are genuinely curious and want to learn and develop and be thought leaders in that regard. [00:04:00] That's really given me some pause for thought
Sharee Johnson: Rhea made her choice to be a general surgeon, uh, partly because of a value around community and looking at, at general practitioners and general surgeons in regional area and seeing how they're really embedded in their community and that that was important to her. And, uh, we had the privilege of working together at the Heart of Medicine this year.
Sharee Johnson: The first time, although we've known each other, the first time we've actively done a piece of work together.
Sharee Johnson: And the thing that has stayed with Rhea after that was that feeling of community, and we've heard that lots of times from the people who were at the Heart of Medicine, this idea that there is community. There are like-minded people doing work around wellbeing and self-care and compassion, the art of medicine. There's things that might be a little bit more nebulous that knowing other people are doing that work and having a connection, a sense of community with those people is inspiring and does help us keep going with the work
Sharee Johnson: I asked Rhea about, [00:05:00] um, advice for young doctors trying to choose their specialty, and she said life is long. We touched on sunk cost, as we have in many of these conversations. We also talked about the real value of patient input into learning and developing programs, and valuing the lived experience, the knowledge that patients bring to our learning, in every way, including to be able to pay them for the work and the insights that they offer us, um, when they join us on committees, and planning, a-and conferences, and so on.
Sharee Johnson: And we talked about sponsorship. Again, something we've talked about on the podcast a few times. That sponsorship is different to mentoring. Sponsorship is literally waving the flag for somebody else, even when they're not there, opening doors for people. A really interesting conversation. I think Rhea has thought deeply about these matters of merit and curriculum.
Sharee Johnson: I hope you enjoy listening to the podcast. If you do, please remember to hit the follow button, [00:06:00] subscribe, and leave us a review, and I hope to see you, very soon at Recalibrate, at Heart of Medicine, or engaging in some of this community building work that we're doing together.
Sharee Johnson: Associate Professor Rhea Liang is a general and breast surgeon on the Gold Coast of Australia, and a medical educator, and the MD curriculum lead at Bond University. Dr. Liang researches and advocates in breast cancer, medical education, diversity, and workplace culture.
Sharee Johnson: She has a 'conventional career'. For example, serving on the British Journal of Surgery editorial board and the American College of Surgeons International Relations Committee. But has also been variously described as a diversity advocate, a systems change leader, and 'that noisy woman' for her work with the Operate With Respect project of the Royal Australasian College of Surgeons, and the development of the Australian federal, A Better Culture curriculum.
Sharee Johnson: In 2023, [00:07:00] Rhea became the first Australian woman awarded Fellow of the Royal College of Surgeons of England Honorary. And this honorary fellowship is awarded to surgeons who are internationally distinguished in surgery or have made a huge contribution to the college. Rhea was recognized for two decades of contribution to surgical education and workforce diversity.
Sharee Johnson: What a privilege it is to get some time to talk with Dr. Rhea Liang. Welcome to Recalibrating with Sharee Johnson.
Sharee Johnson: Hello, Rhea.
Dr Rhea Liang: Hello, Sharee.
Sharee Johnson: How are you?
Dr Rhea Liang: I'm good, thank you. And of course, you know, that's a very formal introduction, but we we've known each other for a long time going back, haven't we?
Sharee Johnson: Well, it's just lovely to have time though, isn't it?
Sharee Johnson: It's one thing to know a person, it's another thing to get a bit of time to chew the fat, as we say. So, Rhea, you've worked in New Zealand and in Australia. You're a surgeon. You're deeply involved in medical curriculum. You're very actively engaged in your college at [00:08:00] RACS. Um, you travel often for work, and you're a mum.
Sharee Johnson: How do you manage your life?
Dr Rhea Liang: Um, I don't know. I get asked this often, and I don't. I sort of muddle through it. There's no master plan, I don't think. And I think, you know, there's no magic solution to it, and I suspect I'm doing exactly what plenty of other working parents are doing all over the world, everywhere, all the time.
Sharee Johnson: Mm. Is it a quest to, um, be busy, to contribute, to role model to your kids? What are, what are the motivations do you think for this busy way we live our lives?
Dr Rhea Liang: I don't know. I mean, I'm lucky in a way. I try and do two things at once. So I can't just sit down and watch TV. I will sit down and watch TV and do the ironing or do the minor mending jobs, you know, sticking buttons back on school uniforms, all that sort of thing.
Dr Rhea Liang: Um, and I suppose I'm doing three things at once when I think about it. You know, like, I'm watching TV, I'm doing the minor odd jobs, but [00:09:00] I'm also servicing my autism 'cause that's a fidget activity for me. Mm-hmm. So for instance, right now even as we're interviewing, you know, my hands have to be busy and so, you know.
Dr Rhea Liang: there's a piece in action below the waterline.
Sharee Johnson: Bring on the crochet.
Dr Rhea Liang: Yeah, that's it.
Sharee Johnson: Yeah, um, it's a challenge for me because, you know, I really help ... I talk about mindfulness a lot and help people think about single tasking and, um, you know, the research says that that's the way that we can be most efficient, but that's not your experience, is it?
Dr Rhea Liang: No. So that's one of the things that we need to learn about neurodiverse people. At times I've been criticized when I've been crocheting in meetings that I'm not paying attention, and that might be true for a neurotypical person, but for a neurodiverse person actually what the evidence shows is that, um, low cognitive load, repetitive manual movement increases attention and improves concentration.
Dr Rhea Liang: And that of course is why we give kids fidget toys now, because we know that now. Um, so you know, that's all just [00:10:00] part of society now learning about neurodiversity and how to get the best out of neurodiverse people.
Sharee Johnson: Mm-hmm. And it's a, it's a problem with applying a recipe, isn't it? That we really want- Yes
Sharee Johnson: to keep remembering. Yes. It's the first lesson of psychology at university, individual difference, and I think that's really-
Dr Rhea Liang: That's it ...
Sharee Johnson: um, we've come a long way since I was at university in understanding what that might really mean. How did- That's it ... how did you arrive at the choice for medicine, Rhea?
Sharee Johnson: What was the thing that helped you, or when did you know you were gonna go to med school?
Dr Rhea Liang: Um, I didn't know I was gonna go to med school, but I wanted to for a long time, partly 'cause it was the family tradition. So I'm a fourth generation doctor, so my father, my grandfather, and my great-grandfather were all in the medical profession.
Dr Rhea Liang: And of course a, an array of, you know, uncles and great- great uncles and all that. Um, the generation before me was the first one where women first went to medical school. For example, I've got an aunt who's a now a retired cardiologist. I guess, I mean, it's different. Some, some people may know my [00:11:00] much more famous younger sister, Roseanne Liang, who's a Hollywood director of some note and just recently won a Hugo Award.
Dr Rhea Liang: You know, she had no interest in medicine whatsoever despite growing up in the same household with the same influences. And so that's just, uh, you know, e- evidence, I guess, that it's partly nurture and partly nature. Um, but certainly growing up with, um, you know, adult relatives talking about medical things around the table and being surrounded, as it was in the internet days, with textbooks and papers, 'cause, you know, you couldn't just look things up on your phone, so we had a quite extensive medical library at home.
Dr Rhea Liang: I was always fascinated by that stuff from quite a young age. And from about 13 or 14 my father who, um, English as a second language, would give me his manuscripts to turn into natural English, so to speak. Um, and so even at 13 or 14 I was starting to learn the, the sort of academic language and how people phrased it and, you know.
Dr Rhea Liang: [00:12:00] So by the time I got to university I think- It, it was much more natural to me, I noticed, than some of my peers who had come from families where either there was no doctor in the family or in effect sometimes there had been no one who'd ever been to university in the family. Um, and I think that was quite key to some of my early thinking about privilege and diversity and the unseen barriers that people face that we don't talk about, and why the discussions about choosing people on merit are quite narrow.
Dr Rhea Liang: Like, we're measuring a very specific kind of merit, um, based on exams and things. But we don't often Rhealize that to achieve that same benchmark some people have actually overcome or come a lot further from where they started. And surely we should start recognizing that when we select people for medical school.
Dr Rhea Liang: So now I'm in the privileged position where I can have some influence on sort of those [00:13:00] policies. Mm. Yeah.
Sharee Johnson: Yeah.
Dr Rhea Liang: Sorry, that's a very long-winded way of answering your original question.
Sharee Johnson: No, that's, that's terrific. Was there, was there pressure from home? Did you feel even unspoken pressure especially if your sister wasn't going into medicine.
Sharee Johnson: Was she older or younger than you?
Dr Rhea Liang: No, so she was the younger one. My older sister was already in medical school.
Sharee Johnson: Uh-huh.
Dr Rhea Liang: So of course my older sister is a pediatrician of some note. Um, and, um, there wasn't pressure so much for medicine specifically, 'cause we've got plenty of people in the family who haven't gone to medical school.
Dr Rhea Liang: But there was always a pressure to push hard and achieve the best that you possibly could. Mm. So even the, um, relatives who have gone on to, say, the fine arts have, have pushed themselves and achieved well in their- specific areas. I think it was a focus on excellence, not so much medicine.
Sharee Johnson: Mm. And, and you were growing up in New Zealand?
Dr Rhea Liang: Yes. Is that
Sharee Johnson: right? Yeah. Mm-hmm. And so you went to med school in New Zealand.
Dr Rhea Liang: Yes.
Sharee Johnson: And what happened to help you come to [00:14:00] Australia?
Dr Rhea Liang: Uh, the husband.
Sharee Johnson: Ah. That's a short answer.
Dr Rhea Liang: Yeah, yeah, yeah. So, so the two of us, um, became consultants, um, at the same hospital in Auckland, Middlemore. And I, and we had been there for all of three months when my husband got headhunted, um, over to the Gold Coast.
Dr Rhea Liang: And initially the plan was just to come over and do a year or two, um, contract. Um, uh, of course one thing, you know, led to another and we just never went back. But we still have our ties there.
Sharee Johnson: What's medicine brought to you, I guess, that's been unexpected or surprising?
Sharee Johnson: What have been the, the, the positives and negatives of your medical life so far?
Dr Rhea Liang: Yeah. So I guess because I grew up in such a medical family, not much of the actual practice of medicine was that much of a surprise. 'Cause I'd been surrounded by talk about it. You know, quite common for my father and either family members or peers that had come round for a visit [00:15:00] or social Rheasons, um, to chat about, you know, difficult cases or challenges they'd met or diagnostic dilemmas.
Dr Rhea Liang: You know, all that sort of thing was very normal to me. But I think what has surprised me since then is that no one ever told me that medicine could be- so diverse or, or h- offer so many options. Right. Um, at medical school it was very easy to think that there were maybe five big specialties that you could choose, and that the big aim was to get selected into specialty training as fast as you could.
Dr Rhea Liang: Which I duly did because that's what Rhea does, you know? Set your sights on a goal, do it. Um, and so I was quite lucky to start my advanced training in my PGY4 year, which is quite early as far as surgical training goes. So I was quite lucky to get onto surgical training early. Um, but as I went through, opportunities just popped up, you know, to join committees or start doing advocacy work.
Dr Rhea Liang: And of course being autistic, I can't read social situations for the life of me, but I am very logic driven. [00:16:00] I mean, that's a key factor. And so when something seems wrong, you just kind of go, "That seems wrong." Um, and so a lot of things seemed wrong. You know, um, indigenous health seemed wrong. Um, the fact that there were almost no indigenous doctors around seemed wrong.
Dr Rhea Liang: The fact that there were almost no women in surgery seemed wrong. Um, you know, all of these sorts of things. And I guess people get to know that Rhea just blurts out stuff when she thinks of it. And that in a way, I mean, that can be a disadvantage 'cause a- as you pointed out, I'm the noisy woman. But it's an advantage when the social change happens and people think we need someone on this committee or to contribute to this panel or to think about policy work, um, and you kind of pop...
Dr Rhea Liang: I guess I just pop into their mind. So no one had told me that all those things were possible. Um, and I've been very fortunate that way.
Sharee Johnson: I want to come back to a couple of things, but do you enjoy that work, Rhea? Do you enjoy being on committees and thinking about policy and driving change and, and wondering how can we [00:17:00] address this gap that I've noticed?
Sharee Johnson: Do you enjoy that work?
Dr Rhea Liang: Yeah, it depends on the committee. Um, so there are some committees where after a few meetings you're like, "We're not achieving anything." You know, this is a committee that could've been an email. Um, and there are other committees that are entirely invigorating, like it's full of like-minded people, things get done.
Dr Rhea Liang: You know, the work might be hard and it might take a couple of years, but, you know, you get there. Um, so an example of that, um, uh, the Rheason why I keep being involved in the Royal Australasian College of Surgeons, for example, is because it has that sort of agency to it. Um, which, you know, might be buying a little bit into the surgical stereotype 'cause, you know, we like to think that we just get things done.
Dr Rhea Liang: Mm. Yeah. But, you know, it's taken us two years now to get the, um, menopause policy through all the various hoops. It's just waiting for executive sign-off now. But although it's been hard work, and we've had a lot of feedback, the point is everyone who has provided that feedback or been involved in [00:18:00] it, um, even when they were part of the hurdle, like a certain committee that we had to pass, you could see that they were all rooting for it.
Dr Rhea Liang: You, you know, like they essentially saw the value in it and wanted- it to go through, but just needed something changed or something to be improved and that's, I love that
Sharee Johnson: That, that feeling of momentum and, and shared collaborative work.
Dr Rhea Liang: Yeah, yeah. Yeah. It's, it's affected my thinking about, you know, in Operate With Respect, 'cause people will say, you know, criticism can come across as bullying.
Dr Rhea Liang: You have to be careful. And I'm like, it depends very much on the context.
Sharee Johnson: Mm.
Dr Rhea Liang: Because if you're in a place where, you know, like I said, it's the committee that could have been an email and it's just unproductive and people start criticizing each other, that can come across very differently to being in a committee where you're doing hard work and people have to be frank, and it could sound mean, particularly if you write it down on paper.
Dr Rhea Liang: But the thing is, because of the social context of it, even when you have to be quite frank with each other, it [00:19:00] doesn't come across as bullying.
Sharee Johnson: Mm.
Dr Rhea Liang: Y- you know, and I think in a lot of HR work, we still haven't quite disentangled that level of nuance when we try and decide what's acceptable or unacceptable behavior.
Sharee Johnson: Mm. It, it sounds like to me when you're describing that, that trust is so vital in that process. Mm. Is that, do you think that that's a part of the problem when, so-called problem, when we're thinking about HR matters and HR responses to these kinds of challenges, like bullying and harassment?
Dr Rhea Liang: I think trust is part of it, but there are people that I trust very much, but I know I won't change their minds.
Sharee Johnson: Mm-hmm.
Dr Rhea Liang: And so I think there's two parts to it really. There is trust, but there's... Sorry, I said two parts. Three parts now that I think about it. So there's the trust, there's the willingness to engage in dialogue and to be honest- Mm ... and then there is that [00:20:00] ability to adjust or change your mind. And I think the people I admire most, and the people that have been most effective in this space, are the ones who have been able to change their minds.
Dr Rhea Liang: So I have had mentors who have said, "You know, I know 10 years ago, Rhea, I told you that you had to act more like a man to get by, and actually now that I've reflected on it, that was not the right advice and I'm really glad that you ignored me."
Sharee Johnson: You know? Well, that's, that's lovely for you too to see the growth those, I suppose, in, in those people.
Dr Rhea Liang: Yeah.
Sharee Johnson: It's interesting that you use the word dialogue. I've been doing some study about dialogue and, this idea that dialogue is what emerges between the two of us. It's not me trying to convince you or you trying to convince me. It's, it's something that emerges between the two of us, that we're both staying open to see what can happen here.
Sharee Johnson: Mm. And these committees that have worked, if you like, more effectively, is that, is there some of that sense in those committees that we're, we're discovering what can emerge, we don't know the answer yet?
Dr Rhea Liang: Yeah. And some of these committees I chair and, and [00:21:00] you take those learnings from other committees you've experienced and you think, "Okay, the agenda is really ideally a series of questions."
Sharee Johnson: Mm.
Dr Rhea Liang: You're not saying, "Here is a policy. Please sign off on it." You're saying, "What do we think about this policy?" You know? And, and so yeah, setting up that space for dialogue and, of course, whether you're the chair or a participant, kind of moderating both the culture and the content so that it's productive, and noticing.
Dr Rhea Liang: Just being very alert. Um, and I think this is where the autistic kind of th- because autistic people don't actually notice these things particularly well. However, if you have early intervention, you've been trained how to deliberately notice, I think in some ways you ac- can actually do it better than a neurotypical person, because for us it's a very conscious decision.
Sharee Johnson: Mm.
Dr Rhea Liang: To sit there going, "All right. I'm gonna put on my social noticing antenna," and I notice that person's leaning back from the table. [00:22:00] I notice this one hasn't spoken for five minutes. I notice that other one is fiddling with their pen and probably wants to say something but is kind of trying to decide whether to or not.
Dr Rhea Liang: And so as a chair, of course, you can say, you know, "Bob, you look like you're about to say something," and that gives them the chance to say it. But even as a peer you can kind of go- "Bob, did you want to say something?" You know? Or, yeah. Mm. You know, that, that sort of drawing people out.
Sharee Johnson: Yeah. It's this intentionality that, that's striking me a bit as you describe it.
Sharee Johnson: I want to go back to something else that you talked about. You, and we'll come back to Operating with Respect absolutely as well. You talked about choosing on merit. Can you say some more about that? 'Cause I think people get in a tangle about this particular thing. How do, how do we choose on merit, and surely choosing on merit is the right thing to do.
Sharee Johnson: And can you tell us a little bit about your thinking in this space?
Dr Rhea Liang: Yeah. So I'll start with the data. There's been decades of research about how to select people for medical school, for surgical [00:23:00] training. The long and short of it is that none of us have got a perfect system. In fact, most of us barely have a good system.
Dr Rhea Liang: It doesn't matter what metric you decide to measure them by, how people do when they actually become, uh, doctors or become specialists bears very little relation to how well they, uh, presented on whatever metric you chose when they came in. The other bit of data we have is from, um, indemnity and complaints data.
Dr Rhea Liang: So we are not getting doctors, uh, you know, getting into difficulty for a variety of Rheasons because they performed below par in their high school examinations, or they didn't know enough maths, um, or, you know, didn't publish enough papers or whatever. You know, those are the metrics that we are currently selecting people on.
Dr Rhea Liang: What they are failing on is, you know, communication skills, social awareness, humility, ability to reflect, um, and [00:24:00] simple integrity. You know, not selling snake oil. Um, so if we think about those bits of data, it's really striking that whenever we try and push for diversity to get more women into surgery or to get more indigenous students, um, into medical school and into specialty training, people say, "Oh, but we just select the best.
Dr Rhea Liang: You know, we select on merit, you know, and they just have to compete with the rest of us." And you're like, but we've got all this data that the way we're selecting doesn't match the outcomes, and the things we select for are not what get people into trouble. Uh, and I think, you know, that's the autistic brain going, "But this doesn't make logical sense.
Dr Rhea Liang: You're not making any, you know, sense." And so it's really interesting 'cause they're often the people who call out loudest to say, "We have to follow the evidence." And you're like, yeah, but you are personally not following the evidence when you make these unevidenced statements about choosing the best.
Sharee Johnson: [00:25:00] Mm.
Sharee Johnson: What, what's the numbers of women in surgery at the moment?
Dr Rhea Liang: It was 6% when I started training, um, in the late '90s. Mm. It has now tripled, so latest data is that we're up to 18%. Um, we still have a distressingly higher proportion of women who start surgical training who don't finish compared to men.
Dr Rhea Liang: So there's still some inequity in terms of the resourcing or support provided to women. Um, 'cause what we do know that, is that as consultants they outperform the men. We've got quite good data now that women surgeon have got lower mortality, better communication, longer consultation times, more satisfaction, fewer complaints, you know, all of these data.
Dr Rhea Liang: And I don't think it's a gender thing. You know, if anyone's kind of feeling a little bit hurt or wants to accuse me of beating up on the men, I don't think it's a gender thing. I think it's a selection thing. You know, the women have in- have overcome so many barriers along the way that you're getting a more [00:26:00] selected, highly excellent cohort of women surgeons, um, compared to the men.
Dr Rhea Liang: I don't think it's an essentially gender coded thing that, you know, any particular gender is better at surgery innately.
Sharee Johnson: Mm. Y- you yourself, um, I think you, I think you first thought about being a general practitioner before you were a surgeon, became a surgeon. And then I think also you've had some times, um, where you thought you might not carry on being a surgeon.
Sharee Johnson: I think you've talked about one of those times being, ... I don't know if you were pregnant or whether you, one of your kids had been born. Can you tell us about what it's really like to meet some of these hurdles and wonder, can I keep going as a surgeon?
Dr Rhea Liang: Yeah. So I wanted to be a general practitioner.
Dr Rhea Liang: Um, I love general practice. I loved the variety of it. I loved the flexibility of it, um, and the way it kept you grounded very much in the community. Um, and at that point I had a, an almost active desire [00:27:00] not to be a surgeon 'cause my initial surgical experiences had been quite negative- Mm ... um, i- in, during medical school.
Dr Rhea Liang: But in my first few postgraduate years I landed in a small hospital in New Zealand. So my, um, husband has got family there, and so we were working in this tiny town called Rotorua. And at Rotorua Hospital, I mean, they know who they are 'cause there were only four general surgeons there. Um, but they just showed me an entirely different side from what we had seen in a highly academic center.
Dr Rhea Liang: So these were not academic surgeons. They were very much grounded in their own community. Um, they had a very diverse practice. You know, general surgery in a rural setting back then included, you know, a bit of minor orthopedics and a bit of definitely most of urology and, you know, the occasional bit of pediatrics when it came in.
Dr Rhea Liang: You know, it, it, it started me thinking in a really different way about whether surgery could be for me. And then there was the whole match up of my need for a [00:28:00] fidget activity and the specialty. So, you know, as I crochet now, it was the same thing. It was like I was so happy when I was operating. Just standing there, just doing, fiddling along, you know.
Dr Rhea Liang: Mm-hmm. And it's like- You
Sharee Johnson: did.
Dr Rhea Liang: I know. And hey, presto, you're like, "I just saved someone's life and all I did was fiddle." Um . You know, I took out their appendix or I chucked in this row of perfect little stitches or I've replumbed their gastrointestinal tract. You know, it, it was just sort of like, oh my goodness.
Dr Rhea Liang: Mm. You know, this is perfect.
Sharee Johnson: Mm. So that sounds, on the face of it, or at the beginning it sounds like it was a major recalibration, but it was sort of an iteration more than anything. It was- Yeah ... you know, in terms of being grounded in community and these values that you were wanting to, to live.
Dr Rhea Liang: Yes. And so at the medical school where I work now, you know, we try and expose our students to more of those diverse experiences. So we have lots of rotations in rural and remote areas and in the community. Um, you know, based on my thought that really my [00:29:00] only conception of surgery at that time was that sort of city-based, highly academic, very pressurized, uh, surgical setting.
Dr Rhea Liang: But also to kind of say to them, look, the world is your oyster. There are medical jobs that haven't even been thought about. You know, who would have even thought about that interface between medicine and AI, for example? Um, and yet we have graduates who are very successful, being entrepreneurs and setting up businesses on that.
Dr Rhea Liang: When we think about what we're trying to graduate now from our medical schools, it's less about, you know, do they know medicine, do they know surgery, do they know psychiatry, all that sort of thing, and more do they have the right mindset to deliver excellence towards the goal of health, you know, with integrity.
Dr Rhea Liang: So I don't want them, you know, becoming, you know, getting into the snake oil or, or not being evidence-based. But they need to be adaptable and to be able to do well in whatever spaces open up for them as they go through. [00:30:00]
Sharee Johnson: Mm. I, I, I love that, Rhea. I spend a lot of time telling people in coaching, , sessions that this is an incredible time to be a doctor.
Sharee Johnson: There's never been a wider span of things that doctors can do. Yeah ... business and other places are starting to really appreciate what doctors offer when doctors come to work inside businesses in terms of their, their clinical Rheasoning that they can apply in other ways. This, this- Mm
Sharee Johnson: process of judgment and, and stepping through the evidence, if you want to call it that, to try and Rheach a decision is, you know, so well trained in doctors that other places are starting to understand the value of that. Um, I, there's some ambivalence for me in saying it in that way because y- you know, we need to keep as many doctors as we can in health.
Sharee Johnson: Um, so, so, you know, I like to think of both/and as far as that goes. Um, our young doctors do feel a lot of pressure to choose the right specialty. I ask most of the senior doctors that come and talk to me here on the podcast, um, what advice they would give our [00:31:00] younger doctors about kind of choosing the right specialty or how to, how to make that decision and, and what happens, like some of the, the, the women surgeons and, and the men surgeons who feel like at three or four years in, oh, I've made a mistake.
Sharee Johnson: This is not the specialty for me.
Dr Rhea Liang: Mm,
Sharee Johnson: mm. What's your counsel for that situation?
Dr Rhea Liang: Life is long. Mm-hmm. You know, you've got to weigh it up for yourself. Are you going to do what you're not enjoying for another 30 years? You know, people, I, I get people in their 30s and 40s saying, "I, you know, I've trained for so long, and I've invested so much," and particularly if they've bought their own practice and have, you know, a squillion dollars invested in their rooms.
Dr Rhea Liang: And I'm like, "Yes, but is that going to be worth it for the next 20 or 30 years?" You know, heaps of people outside of medicine retrain in their 30s, 40s, 50s. I mean, you can go to university and find 70-year-olds doing PhDs. It's like, it's an interesting thing I've observed, that these are people who [00:32:00] succeeded on getting into medical school.
Dr Rhea Liang: They're already in the top one or 2% of performers academically, and yet they've got themselves in the position where they think they somehow can't learn something new. You're like, wow, where did that come from?
Sharee Johnson: Mm.
Dr Rhea Liang: Um, so I guess in that coaching style, I, I, I mean, I'm not a trained coach, but sometimes you feel like you're coaching people and going, "Think a little harder about what you're saying.
Dr Rhea Liang: Why, why do you believe this?"
Sharee Johnson: Yeah. Yeah, I think that challenging of any limiting belief, and we can often, uh, see and hear the other people's limiting beliefs so readily. Mm. Um, you know, they're obvious, aren't they? And, and that in some ways that's the easy part of coaching, that you hear these stories- Mm
Sharee Johnson: these limiting beliefs and think, well, where did, where did that come from? Why? Why do you believe that?
Dr Rhea Liang: Yeah, yeah.
Sharee Johnson: What else? What else could be true here? Um-
Dr Rhea Liang: Yeah ...
Sharee Johnson: I wrote in my book about competition and perfectionism and stoicism, these things that are really valued, uh, in medicine and, and-
Dr Rhea Liang: Mm-hmm
Sharee Johnson: promoted really and [00:33:00] encouraged.
Dr Rhea Liang: Mm-hmm
Sharee Johnson: What, what's your take on wellbeing for doctors in that kind of environment, this feeling of, you know, sunk costs and expectations and, you know, they're, they're big things that not only the doctor puts on themselves, but often their family and certainly their community has high expectations of them.
Sharee Johnson: Yeah. What's important for doctors to think about around wellbeing and mental health, do you think?
Dr Rhea Liang: Yeah. We've got a big professional mind shift that we have to achieve, and we're, we're getting there. Like, you, you can start to see the ship is slowly turning in the water. Um, but it doesn't take ma- much for it to slide back.
Dr Rhea Liang: So, so the shift we have to make is that for a long time it was believed that the doctor who could deny themselves, you know, the food, the water, the toilet break, their own wellness, was a better doctor for others. Now, I have to go back to the data here. None of that is true. You know, we've got so much evidence that being dehydrated affects your mentation, that being tired affects your mentation, that being [00:34:00] cranky or witnessing other people being cranky affects your performance.
Dr Rhea Liang: Um, you know, that people who have been awake for 16 hours function about have Rheaction times that resemble drunk drivers, and, and yet we've still got this notion that i- you know, somehow laudable or, or dedicated to your patients to let yourself get that tired, that hungry, that thirsty.
Dr Rhea Liang: So it's really good now that, you know, I'm one of many people starting to speak up about this. But it takes a long time to change the culture. Um, and so it's not uncommon for people of my generation to pop up with a, "Well, back in my day," or, "The youngsters are too soft now. They don't know what it's like to work a roster," or, you know, blah, blah, blah.
Dr Rhea Liang: So- I think it's that thing like we say trust and dialogue and being willing to change our minds. You know, these are conversations that we just have to keep having gently, repeatedly. You know, not to make them an argument, but just to kind of go, "Yeah, yeah, no, that's not right." You know. You know people should have fatigue [00:35:00] leave.
Dr Rhea Liang: Mm-hmm. You know people should go home after they've been up for this long. Um-
Sharee Johnson: One of the things that, uh, medical people, and I don't think it's only doctors, certainly psychologists fall for this too, and I think probably nurses and, and allied health too, that, you know, but what about the patients who are still waiting, or what about the patients on the waiting list?
Sharee Johnson: Or, you know, that's a huge burden that healthcare workers carry, that knowledge that there are still more people waiting, and who will see them? That's a huge trap that I think we can all ... Feels, feels to me like a bit of a spiderweb that you get caught up in this sticky, this sticky story that's hard to extract yourself from.
Dr Rhea Liang: And that kind of tells me we're selecting the right people. Like, they have heart. They really care. They don't want to let people suffer. Mm-hmm. But there comes a point where you have to say, "Look, that is the system." You know, that is a system that doesn't employ enough doctors to run a safe roster and does not have enough fat in the system to cover sick leave.
Dr Rhea Liang: Um, you know, because they assume they have been able to take for granted [00:36:00] that they will get 10 or 20% more work out of doctors than they actually pay them for. Um- Each person has their own limit. You know, I'm not going to judge anyone who decides that they are going to burn the candle. Uh we have the saying, you know, burn the candle at so many ends that it's turned into a sphere.
Dr Rhea Liang: Um
Sharee Johnson: Never heard that before?
Dr Rhea Liang: Yeah, but it's, it was, it, it all, uh, you know... So we used to say burning the candle at both ends. Yeah. But then we had that lifestyle thing where people were selling those round candles with like three wicks or four wicks in them. Mm. And, and then people were saying, you know, "I feel like I'm burning all of my wicks all at once."
Dr Rhea Liang: All wicks, yeah.
Sharee Johnson: And
Dr Rhea Liang: so, yeah, this expression came that, you know, I'm burning so many- ... so many ends on my candle that it's turned into a sphere. Um, but so, so, you know, everyone has their own sort of personal, um, balance point where they decide, you know, I'm too tired to carry on. This is a system issue.
Dr Rhea Liang: I have to walk away even though I don't want to let people suffer. For some people that [00:37:00] will be earlier, for others that will be later. But what we do want to avoid is people kind of pushing on and pushing on and pushing on to the point where it just turns into a crisis. Mm. Like, you know, I see so many doctors in distress who haven't stopped until they literally sort of-
Sharee Johnson: fell down
Dr Rhea Liang: hit, hit the brick wall.
Sharee Johnson: Yeah. And it's- And it's frightening. I mean, the error rates for any of us in those states are- Mm ... you know, frightening. Mm. That's frightening for the person trying to deliver the care even albeit very well intentioned.
Sharee Johnson: Mm. And for the patients. Some of the work that you do is about trying to bring more patient stories to medical students. Yes. Can you tell us a little bit about the genesis of that or, or how you do that from Bond University or just tell us what you're doing.
Dr Rhea Liang: Yeah. I mean, part of it is as I get older, you know, on occasion I am the patient, and it's really interesting what you notice- Mm
Dr Rhea Liang: from a patient point of view compared to what you notice-
Sharee Johnson: Yes ...
Dr Rhea Liang: from [00:38:00] the doctor side. We like to think we're observant, but actually, you know, lying in that bed wearing the terrible ill-fitted pajamas staring at the ceiling is really a very remarkably powerless place from which to observe the world go by.
Dr Rhea Liang: Anyway, so that's part of it. Um, but the other part too is that I don't know why it is, but I've always felt that patients were somewhat excluded from the way that doctors were socialized into the world of medicine. There were a few sessions when I went through medical school where they would bring patients in to talk about their experiences.
Dr Rhea Liang: Those were very poorly attended.
Dr Rhea Liang: And, you know, Ben Bravery has written a book where he talks about this, , he has a personal experience of being a cancer patient, and when he was training be- to be a doctor after that experience, he felt that more patients like himself should be heard, and so he organized these sessions, and no one turned up.
Sharee Johnson: Mm. I think that's just s- just such a sad [00:39:00] story.
Dr Rhea Liang: Yeah. It's, it's not prioritized. You know, it's not seen as important. Anyway, um, I've been very lucky though. There's been a significant change, and now I have, you know, many consumers. And so, I mean, I don't like the terminology of consumers, but there's much more involvement of patients in the design and delivery of medical care and in, uh, the committees that make decisions about how that care is designed, um, and in my research work.
Dr Rhea Liang: That has been the first challenge, you know, making sure that the consumer or the patient is there and has a voice. What has been much more challenging is making sure they're being paid.
Sharee Johnson: Mm. I don't know if you know Sue Robins from Canada at all, but she talk- she's been on the podcast, and she talks a lot about this valuing the patient voice.
Sharee Johnson: Mm. E- even to the very smallest things of, um, making sure they've got somewhere to park if they come to your event. Mm. Or, you know, walking them out afterwards, not just sort of letting them wander out and find their way out of your confusing maze-like hospital. You know, those kinds of things.
Dr Rhea Liang: [00:40:00] Yeah, yeah.
Sharee Johnson: Um, so are you, are you doing your work with patients, um, through the university, through Bond University and through RACS? (Royal Australasian College of Surgeons)
Dr Rhea Liang: Yeah. So, so everywhere I go, um, and in the Better Culture project that was Commonwealth funded. You know, we made sure that there were consumers at all levels, and that they were paid.
Dr Rhea Liang: That was actually built into the budget. Um, and we weren't just kind of paying them, you know, what we thought they were due. There's actually a consumer advocacy organization in Australia that sets rates in a union style. And so we made sure that we were paying them that rate or higher, um, to value the time that they put in.
Dr Rhea Liang: Um, and I think that's a change that needs to happen.
Sharee Johnson: What's been the impact, Rhea, in terms of learning? Have you been able to gauge how that's affecting the learners?
Dr Rhea Liang: Yeah. It's really important, um, because, there's this kind of perception that there's the doctor ... W- we talk about the doctor-patient relationship.
Dr Rhea Liang: [00:41:00] Um, and we talk about, you know, health consumers versus health professionals. But all of us are going to get sick. You know, in time, particularly as we get older. And the converse, it's like everyone who's had a health, uh, experience has learnt something from that and has the expertise of their lived experience.
Dr Rhea Liang: And what would I trust more, someone who's had a lived experience of something and says, you know, "This is what I found really helpful," versus the doctor who says, you know, "This is what the data shows me. This is what the research shows me"? In actual fact, lived experience can be much more powerful because it's genuine.
Dr Rhea Liang: It's not that either patient or professional viewpoints take precedence over each other, but the thing is we have to listen to both. I mean, that's the thing, isn't it? Like this morning I had a small electrical light on that malfunctioned, and I popped out the batteries and of course one of them had corroded, and you had all those little sort of funny white crystals on the thing.
Dr Rhea Liang: Mm. And so I'm there on the social media as you do, going, "How do you clean these battery contacts?" And [00:42:00] someone will go, "This is what worked for me," "Do this, do that." We prioritize that lived experience in our daily lives all the time. I'm not quite sure why it is that medicine doesn't.
Sharee Johnson: Mm.
Dr Rhea Liang: I'm sure there's a sociological sort of ex- explanation for it, but-
Sharee Johnson: Well, I think Victoria Lister would have something interesting to say about that because she talks about, the professions. Not just medicine, but how professions develop and how they develop their culture and how they then maintain their culture.
Sharee Johnson: Um, quite- Yeah ... unconsciously a lot of the time. We were talking about consciousness earlier. You know, it's built in. We don't even know we're doing it until we- Mm ... point it out. And I think, you know, now that patients are more actively involved and more health professionals are saying, "Can we get some patient voice in here?
Sharee Johnson: What do they say about this?" Uh, that- Mm ... that might interrupt th- those, those cultures. Is that your experience?
Dr Rhea Liang: Yeah. Yes. Very much so. Um, I mean, the hierarchies have to go. Uh, social media has put us all on the same playing field [00:43:00] anyway. Um, and I learn so much from lived experience. There's so much in breast cancer care, for example, that is not taught.
Dr Rhea Liang: It's not in any textbook. It's not ... You know, people, women will say, "So after I've had, you know, mastectomy and reconstruction, how do I size my new bra? How do I go about this? What are the good bra brands? Which ones won't rub on my scars?" You know, that's all stuff that you learn from talking to the patients and listening to their lived experience.
Dr Rhea Liang: You're not gonna find it in the literature. But it makes such a big difference for the next patient who comes along who has the same question. I'll be like, "Ah, you see, this is what I've found. You know, here are the shops you go to, or these are the brands that other women have found useful. And, you know, here's their tips and tricks for sizing your bra, um, for the bit where you're terribly swollen and the bit six weeks later when it's changed completely."
Sharee Johnson: Mm. I'm wondering, um, listening to, to you, what happens with the silos? You know, we've had lots of subspecialties and silos in medicine that have [00:44:00] probably, um, led to, doctors not having that, that kind of information, and perhaps thinking that it's not their role to have that kind of information.
Sharee Johnson: And that the, with social media and the flattening of some of the, information channels, these roles are changing a little bit. And this whole person, if we're talking about whole person medicine- Mm ... then, uh, this, these little pieces of information that might seem incidental or not quite, you know, what you've been trained for -
Dr Rhea Liang: Mm.
Dr Rhea Liang: Exactly ...
Sharee Johnson: might actually make all the difference to the healing and the care and the wellbeing of the patient.
Dr Rhea Liang: That's it. That's it. And, and, you know, if we genuinely feel that we are here to help patients, you know, to improve their health, then we really need as a profession to wrap our heads around some of that more holistic stuff and not think that we are just here to operate and prescribe things.
Sharee Johnson: Um- It's gotta
Dr Rhea Liang: be
Sharee Johnson: more satisfying, Rhea, more fulfilling. Is it?
Dr Rhea Liang: It is. It is. I think in some ways we signal that. So when I started getting these questions, I would ask some of my colleagues, and of course back then most of my colleagues were [00:45:00] male, and they'd be like, "We don't know. We've never been asked this."
Dr Rhea Liang: And so then when you say to patients, "Why would you not ask my colleagues that sort of question?" They'd be like, "Oh, no. Well, he wouldn't be w- interested in that," or, "He wouldn't know." So they self-censor.
Sharee Johnson: Mm.
Dr Rhea Liang: And so you're thinking, well, A, that's nice to know that they don't self-censor around me, but B, how- shameful in a way, is it?
Dr Rhea Liang: That patients feel they have to self-censor from asking genuine questions of their doctors. Yeah. Yeah, it shouldn't have to be that way.
Sharee Johnson: No. I think there's a lot of shame in medicine. . It's not a word that I used very much in the ear- my early work. It's becoming a more and more common word in the work that I'm doing.
Sharee Johnson: And I think it- Mm ... that the doctors are using as well, that we're starting to recognize that let's give this a name, and then we can actually attend to it.
Dr Rhea Liang: That's it. That's it.
Sharee Johnson: Yeah. Let's keep moving. Academia's not known as a place where change happens quickly.
Dr Rhea Liang: Mm-hmm. Yep.
Sharee Johnson: And there's so much information and, you know, lots of people are really seduced by AI. [00:46:00] I've got my own misgivings about AI. I'm concerned about the skills we're gi- giving up as we, um- Mm ... give over to the machine. And I'm also really skeptical and concerned about the environment, so I have my own, um, issues to work through there with AI.
Sharee Johnson: But what's the impact of all this information and AI and, and also the kind of, you know, continuing human cry of burnout in, in medicine, still hovering around 50%, varies across the different specialties. How does all of that affect your thinking about curriculum when you're thinking about teaching medicine right from the beginning?
Dr Rhea Liang: Yeah. So in curriculum work, we are moving quite rapidly. I mean, we had been already even before AI, but we're moving away from the idea that medical school is there to convey knowledge.
Sharee Johnson: Mm.
Dr Rhea Liang: You know, we are not the knowledge holders, partly because the pace of medical knowledge growth has accelerated so much.
Dr Rhea Liang: When I went to medical school, Index Medicus, which was the precursor of what's now [00:47:00] PubMed, used to arrive once a year on the back of a truck, and it had about 24 volumes, and that was the sum total of medical literature that had been published that year, of course. Um, people talk about medical doubling time, you know, the time it takes for medical knowledge to double, and I think it's down to something like 33 days now.
Dr Rhea Liang: You know, that's how much is being discovered and published. So there's no way we're going to teach our medical students to know all that stuff. Mm. What we're really teaching them now is skills, skills to navigate the knowledge, to assess its value, to be a little bit cynical, to pick when, you know, it's a scam, so to speak, um, because there's so many AI-generated papers out there now.
Sharee Johnson: I've have done nothing to verify it, but I heard a thing last week that said that 51% of what's on the internet is generated by robots and the internet
Dr Rhea Liang: Yeah, yeah. The, uh, we, we were joking, you know, the AI-generated papers are spawning their own grandkids.
Dr Rhea Liang: Um, so there are AI-generated papers that are citing literature that is itself AI-generated by someone else. Mm. Um, [00:48:00] so there's entire chains of hallucinated rubbish. Um yeah, and, and this can be really difficult for a medical student to untangle because they don't- Yeah ... have the knowledge base that we had.
Dr Rhea Liang: You know, I can read a paper and go, "That doesn't sound quite right." And then look at the reference and go, "I don't remember seeing that reference." And then you Rhealize that the paper you are currently reading, as well as the literature that it cites, are both hallucinated. But if you're a medical school and you don't have that background to have been around for donkey's years like I have, or to have that sense of what the overall literature is, how are you going to pick that up?
Dr Rhea Liang: And so those are the skills that we now need to teach our students, and the hilarious thing, of course, is our generation never had to have those skills. Um, you know, we never had AI. Indeed. So, so you've got this, uh, kind of curriculum design that's having to run a- run to catch up with what we're trying to teach.
Sharee Johnson: Mm. It sounds awfully taxing, and on the other hand, it's kind of sounds exciting to be involved in that kind of [00:49:00] change where, you're not learning so much to, what can I rote learn so I know it in the exam? But what can I learn? Mm. And are you examining in that same way? Are you examining for a person to be able to think through a problem as opposed to have remembered Rheams and Rheams of theories and protocols?
Dr Rhea Liang: Yes. So we have done quite a lot of work to decide what is core to the curriculum. You know, there are some things that they must know, they just simply have to know without recourse to Google or AI. So, you know, acute resuscitation, acute trauma call, st- status epilepticus, low oxygen saturations, you know, your training and, and, and your knowledge just needs to kick in at that moment.
Dr Rhea Liang: Beyond that though, you know, knowing the 15 causes of heart failure or whatever is less important than knowing the physiology of the heart and being able to Rheason from first principles what might be going on. You know, is this a valve problem? Is this a contractility problem? Is it a pump problem? Is there actually an obstruction that's external to the heart?
Dr Rhea Liang: You know, so, so being able to [00:50:00] understand those principles and h- the sort of hows and whys of it is more important than the what, because the what is changing so quickly, and might in fact be hallucinated. Mm. So, yeah, so, so the nature of what we're teaching students is changing. But nevertheless, there is still quite a large core of knowledge that they must be able to know.
Dr Rhea Liang: You know, this is what essentially distinguishes a doctor from a layperson. You have that core of knowledge from which to proceed, and you've got to be able to haul it up without Google or AI.
Sharee Johnson: Do the, do the medical schools communicate together about this kind of development?
Sharee Johnson: Is there any conversation that goes on between the medical schools, or is it, um, you know, a competitive business and so it, all the medical schools keep their own plans and their own processes to themselves?
Dr Rhea Liang: No, no, no. So we, there's a lot of discussion with each other. So there is an overarching organizing body called Medical Deans.
Dr Rhea Liang: Mm-hmm. Um, which started off as, as the deans of the medical [00:51:00] schools across Australia and including New Zealand. Um, but now includes much more than just the deans. You know, it's still called Medical Deans, but basically it's an overarching organization that, uh, develops and produces policy documents such as, you know, what are the core procedures that we need all our students across the whole of Australia and New Zealand to graduate knowing how to do.
Dr Rhea Liang: Um, or, you know, what are the core guiding principles about bullying, discrimination, harassment, for example. The common, um, concepts that we want to convey to all of them across the board. So, so there is that overarching thing. In addition to that, there's regular conferences. So regular conferences, not just locally, but also internationally.
Dr Rhea Liang: So we're in constant dialogue with medical schools all around the world, because we're all grappling with the same things. Where people will share their work and how it worked and how, how it might not have worked, and all that sort of thing. So it's very collaborative, and I like that about-
Sharee Johnson: Mm ...
Dr Rhea Liang: medical school.
Sharee Johnson: I like, I like that too. I'm very delighted with that answer. So, so let's move, um, [00:52:00] to the RACS work and around culture. About 12 years ago or so, there was, it became evident that there was just too much, whatever too much might be. Probably one incident is too much. But too much bullying and harassment, uh, and discrimination within the faculty of surgeons, if you like to say it like that, um, to be tolerated, that something needed to happen.
Sharee Johnson: And- Mm-hmm ... and that's where Operating with Respect came from. Can you tell us- Mm-hmm ... about what happened to kind of tick that over and make something- happen, and then, and then what the outcomes are? What's, what are you seeing as a result?
Dr Rhea Liang: Yeah. There was a sentinel event that was very big in the media at the time, and in actual fact, for those of us who had been marginalized, you know, say as women in surgery, not just me though, also, you know, indigenous surgeons or LGBTQI surgeons or surgeons from rural areas.
Dr Rhea Liang: It, you know, it was no surprise to a- any of us that this stuff had been going [00:53:00] on for generations. But I think what changed was that society became less tolerant of these things, and so this, this particular event suddenly hit the newspapers, and we had our very public reckoning. On the back of that, the Operate With Respect program was born.
Dr Rhea Liang: Um, uh, I contributed to one part of it, which was the education part, and the education part became the sort of flagship of the whole enterprise 'cause it was the most visible part. And the decision was made at an executive level that we were going to deliver mandated training to all practicing surgeons in Australia and New Zealand.
Dr Rhea Liang: Now, the really interesting thing about this is that people say, "Oh, Rhea, you led this effort." And I'm like, "I actually didn't." So the chair at the time was Adrian Anthony. Um, but what was really interesting to the whole committee was that when the, um, pushback and the denials and the argumentative emails saying, "I don't know why I have to do this mandatory training" were coming in, [00:54:00] far more of them were directed towards me as an intersectional woman than were directed to Adrian.
Dr Rhea Liang: Um, and of course on social media I've been pretty open about posting some of them, anonymized, just to give an idea of what was coming in, 'cause it's pretty extreme some of the stuff. Very racist, very sexist. You know, I was told to go back to where I came from. I was told to familiarize myself with the Australian system.
Dr Rhea Liang: I was told that patients were gonna die because I was enabling snowflakes. Um, yeah, all sorts of things. Anyway, um, we pushed on. , So I had had direct, uh, advice from senior colleagues not to take part in this. They said, you know, "The College has a short memory. They will get you to take part in this.
Dr Rhea Liang: You'll be known as the Operating With Respect lady, and then they'll just leave you out to dry in two or three years and you'll never get a job." In actual fact, that's not happened. The College has stayed its course this whole time. I'm really proud of the College as a whole and the leadership that we've had that whole time for doing that.
Dr Rhea Liang: And so it remains one of our [00:55:00] flagship offerings. Um, and we are the only medical specialty college in Australia that has invested, you know, seven digits plus into, um, this effort. In terms of the results, we are getting them. So change takes time, but what we do know is that while the incidents on paper doesn't seem to have decreased, the egregiousness of it has decreased markedly.
Dr Rhea Liang: Um, so I haven't prepared the slides, but I do have a presentation that I give on the regular to, to interested people, which shows that we've had a very distinct shift away from the very egregious behavior. So the shouting, the sexual assault, um, the throwing things, um, you know, uh, verbalized violence.
Dr Rhea Liang: That has dropped off completely. And so even though the data would show, you know, the rate of bullying hasn't decreased. The point is the actual nature of it is now much more minor. Now, that doesn't justify it at all. You know, we [00:56:00] still have to, you know, now it's down to the sort of the snide comments, the undermining, the unfair rosters, you know, slightly more minor stuff.
Dr Rhea Liang: So you can be quite confident at least that you're not gonna get assaulted on the job. That is good. You know, we started at a very
Sharee Johnson: dark- What, what, what an e- what an extraordinary thing to have to say about- I know ... intelligent, professional people. I mean, that's the, that's the challenge here, isn't it, to, to believe.
Sharee Johnson: E- even when you describe the people that were pushing back against the mandatory training and the way that they were doing that aggressively, uh, rudely, insultingly, um, you know-
Dr Rhea Liang: Yeah, and deciding to address it-
Sharee Johnson: Threateningly
Dr Rhea Liang: Yeah, and deciding to address it to the person that they thought had less power.
Dr Rhea Liang: Mm. That's why it came to me and not to Adrian.
Sharee Johnson: Yes.
Dr Rhea Liang: Yeah. Um, and I think that's why people think that I led it, you know? I didn't lead it. I was the deputy at the time. But-
Sharee Johnson: Mm ...
Dr Rhea Liang: it was clear that I was getting a lot more of that pushback. really the nature of it has changed. We are now dealing with the less sort of overt, uh, [00:57:00] manifestations of it.
Dr Rhea Liang: And in some ways, I think that's actually harder.
Sharee Johnson: Mm. Oh, definitely. Yeah. Do, do you feel like that because of the education people are able to call it out? Like, you might not see it as much i- in your reporting, but, uh, do, do people tell you stories of calling things out and speaking up when they wouldn't have in the past?
Dr Rhea Liang: Yes. Yes. And what's really pleasing to me is that those stories are increasingly coming from trainees.
Sharee Johnson: Mm.
Dr Rhea Liang: Um, 'cause i- in any position of privilege, it's easy to think, oh, we've delivered it and we're, you know, winning 'cause people tell me these things. But what you don't Rhealize is, you know, when you're in a position of privilege, people may not tell you the negative aspects.
Dr Rhea Liang: They'll talk about it around the water cooler or around the printer, but they won't necessarily tell the leadership about it. So it's really meaningful to me when, you know, we always employ a third party, uh, to get our, to do our prevalence surveys and, and do the feedback and the focus groups for exactly that Rheason.
Dr Rhea Liang: And so it's really pleasing to me that we have increasingly now trainees saying, you [00:58:00] know, "I made a complaint about bullying and it was taken seriously and got sorted out." And you're like, "Woo-hoo." 'Cause that never happened when I was a trainee.
Sharee Johnson: I, I think this decision to make it mandatory was an incredibly brave decision for the collective to make that decision, and the, the pushback, um, I guess demonstrated that Is, is it accepted now?
Sharee Johnson: Do you feel like t- you know, 10, 12 years on that it, it's ex- it's just an ordinary accepted part that this is one of the modules I need to do in my, in my training- Yes ... in my professional development?
Dr Rhea Liang: Yes. Yes. So within a few years we had trained all the practicing surgeons and, um, also our SIMGs, so specialist international medical graduates.
Dr Rhea Liang: Um, the trainees started doing it, and now we've got it to the point where even applying for a training position with the College of Surgeons requires you to have done the online module before you even start. Mm. So in some ways we are signaling it even to those who would want to be surgeons in the future.
Sharee Johnson: Mm. And there's ongoing [00:59:00] financial investment. Obviously, there's a, a budget line- Yes ... for this training. Yeah. Do, do you have an understanding about the other colleges? Do the other colleges say things like, "We couldn't do that 'cause we don't have the budget," or w- what, what's
Sharee Johnson: What do you think about the other colleges?
Dr Rhea Liang: Every other college that has done a similar survey has found similar prevalence rates to the College of Surgeons. So there are some colleges who tried to argue that we don't need to do that 'cause we don't actually have that problem.
Dr Rhea Liang: That turns out to be untrue. Um, it might take slightly different forms, but every college has got an internal bullying, discrimination, harassment problem. If they think they don't, it's 'cause they haven't run the research for it yet. Mm. That narrative has decreased over the years. So initially there were colleges saying, "Oh, we don't have a problem with it.
Dr Rhea Liang: We don't need to do what the College of Surgeons are doing." As the years have gone by, more and more of them now are saying, "Okay, we don't even need to run the survey probably. We know we probably have a problem, but we are limited for resources." So that becomes the biggest problem now, um, is the limitation on [01:00:00] resources.
Dr Rhea Liang: And- Unintentionally, the move by the Australian Medical Council to set up something called CPD Homes has fed into that. Um, so all of us need to do CPD now, continuing professional development, a certain number of hours and a certain range of activities every year. But you don't have to do that with your professional college.
Dr Rhea Liang: You can do that with a, you know, commercial company set up for that purpose. But the downside of that is that it has decreased the amount of money basically flowing into the colleges, which is why some of them now have somewhat decreased budgets, um, compared to what they had before and that nowadays ... I mean, even with all the best intentions in the world, there are a number of colleges who would like to do something like the College of Surgeons, but can't, uh, because of resource limitations.
Dr Rhea Liang: And I think that is where I would very much like someone like the federal government to step in.
Sharee Johnson: Mm. Mm. I think we could talk about this for quite a [01:01:00] long time, so I'm gonna move us along. Yes. It's very interesting that what you've just said there at the end. I want to ask you more broadly what you think it means for a doctor to be a leader, and what skills do you think that means a doctor needs to have?
Sharee Johnson: If, if we think of ... I don't agree that all doctors are leaders, unless we're talking about that they're leading themselves. There are some doctors who are really only leading themselves, and they choose that. They don't really want to lead too much more than that. Uh, and of course, there are, um, there is an expectation that of, of other people that we look to the doctor as the leader.
Sharee Johnson: W- what does all that mean for a doctor in terms of skills?
Dr Rhea Liang: Not all doctors have to be leaders, but all doctors should have the skills to become a leader if they need to. Because even the doctor who chooses to just be leading themselves you know, the, the moment you come across someone who's collapsed on the footpath outside your house, you know, Good Samaritan rules dictate that you will stop and provide [01:02:00] assistance- Mm
Dr Rhea Liang: which will generally require you to be a leader even for the next 15 minutes. Mm. So everyone needs to have those skills. Whether they implement them is up to them. I think our conceptions of what constitutes a leader have changed greatly over the years. So the Surgeons as Leaders course already existed when I became a surgeon, but then I started teaching it, and then I was involved in a, a, the, a revision of that particular course.
Dr Rhea Liang: So I've seen the literature as it's applied to surgeons who are in leadership positions change over the years. So we went through the phase when it was trait-based, you know, when it was like, you know, surgeons who are leaders should be assertive and confident and knowledgeable and this, that, and it was just a list of traits.
Dr Rhea Liang: Then we went to the one where it was about leadership styles, you know. So that discussion about leadership styles, of course, is now obsolete, but they'd say, you know, this is a more authoritative style, or this one's more of a, you know, emotional leaders and, you know, thought leaders and all this sort of thing.
Dr Rhea Liang: Um, that's become obsolete. Now what we're talking about is leadership adaptability, adaptive leadership, and versatile [01:03:00] leadership. So it's not that you have a particular style or a particular trait. The point is that you need to be able to tailor your leadership for the situation, and that requires a great deal of emotional and social intelligence.
Dr Rhea Liang: And we've seen that play out so many times in current geopolitics or after the COVID thing. It's like read the room. You know? There are times when you have to become your softer self and listen to people. There are other times you're gonna have to put on your big girl's knickers, so to speak, and take the lead and make some hard decisions.
Dr Rhea Liang: Um, a- and many other variations of it. So I think our current concept of it now is that our best leader is one that can very deliberately read what types of leadership might best suit that circumstance and manifest it, that they have that full range.
Sharee Johnson: Are you teaching social and emotional intelligence to your med students?
Dr Rhea Liang: Yes. M- in a much more deliberate way. Uh, so when I went through med schools, you sort of, [01:04:00] if you were open to it, you sort of absorbed it. Like, you'd see someone and go, "I really like the way they practice medicine, and why is that?" And I think it's 'cause they're emotionally intelligent. But if you weren't open to that way of thinking to begin with, y- you know, you just sort of carried on blithely.
Dr Rhea Liang: Whereas now we teach it very deliberately. We use the language. We give examples of where people are emotionally or socially intelligent or not. Um, and that's kind of all built into their curriculum. And I think the younger generation actually have that language from high schooling as well. You know, they teach them this much better at school than they did when I was there.
Sharee Johnson: Yeah, I think that's true. There's a lot more of that i- even, even in common language, even the fact that we talk about other kinds of intelligences besides- Mm. Mm ... IQ. In our society is a change, isn't it? Mm-hmm. It, it's something that I notice in our Recalibrate program where doctor peers are coming together and talking about situations that they had at work and trying to understand that from a social point of view or an emotional point of view.
Sharee Johnson: Mm-hmm. And I'm, I'm still struck. Most of the doctors that we work with, [01:05:00] with in that program are mid-career, but I'm really struck about how much learning goes on about emotions. Mm-hmm. And, generally speaking in our, um, population, our general population, our vocab for emotions is very limited. You know?
Sharee Johnson: Mm-hmm. The, the average adult has about six to 10 words that they regularly use to describe their emotions. And, you know- Yeah ... for a psychologist, the list of emotions is much bigger than six to 10 words. So I think, you know, that there's still work to be done broadly, not just for doctors, but for all of us about what is the name of this experience that I'm having, and we talked briefly about shame- Mm-hmm
Sharee Johnson: at the beginning. That's, that's an example. , You were a very important part of our Heart of Medicine faculty this year at Uluru, and the, um, presentation that you gave with Dr. Cath Crock and Dr. Andrea Austin around, um, you know, systems, bringing compassion into healthcare systems was very warmly received and, and we're, um, as you know, planning to try and expand on that next year when we get together at Uluru.
Sharee Johnson: What did you take away this year from the Heart of Medicine, um, [01:06:00] in terms of that gathering? What did you pick up from the healthcare workers that were there that's still with you?
Dr Rhea Liang: I think the most powerful thing for me from that conference was understanding that we are part of a community. Mm. Because each of us in our organizations, it's very easy to feel like you're just about the only one constantly banging on about wellness and compassion and looking after ourselves and all this.
Dr Rhea Liang: And so to be able to gather, y- you know, it was very symbolic for me. It was like the heart of medicine in the heart of the country, in the heart of indigenous culture, and really think about what medicine meant to us all. And knowing that even though I still have those moments where I think, "Why am I the only one in the room kind of banging on about this?"
Dr Rhea Liang: You know, I am that noisy woman again. Um, but knowing that there's at least 100 other people in this country who think exactly the same way, and I was able to draw on that strength and feel that I was part of that community for those three short days, you know, it's really powerful. It [01:07:00] sustains me- Mm ... in moments where you can feel very alone otherwise.
Sharee Johnson: I'm really delighted to hear that because that was the initial inspiration, that there's all these people doing this work in separate places. They need to know- Mm ... that they're not by themselves. They're not the only ones. And, and me included, I feel like that sometimes too that, am I the only one who's going on about this?
Sharee Johnson: So yes, I agree. It was lovely for us to be there together and to feel that sense of community. I'm really delighted that you've had that, you still have that feeling too. Um, how do we make change in big systems? What is the, what are the b- two or three or four keys or guiding principles that you think about when it comes to big change, whether it's a better culture or the university or in your own hospital?
Dr Rhea Liang: Mm. The first thing is to understand that you can't make the system change if it's not willing to. Mm. But you can be super well prepared for when it reaches that point. So it's a little bit like the Operate with Respect. Like I said, I think societal change had made some of those behaviors unacceptable, and then we had the sentinel event.
Dr Rhea Liang: And [01:08:00] out of almost thin air we were expected you know, the initial committee that was formed, we were all sitting there going, "We've got how long?" They wanted the program up and running within three months. Now- Wow ... anyone who has run, um, a, a, an education program that is supposed to go mandatorily- Systems
Sharee Johnson: wide
Dr Rhea Liang: to about 8,000 surgeons knows that three months is a really, really short time. But the point was most of us had been working and thinking and developing things in our own little spheres for the better part of a decade and a half, and so that's what it was based on. You know, it's like you can't make that system change if it's not ready to, but- You can be really well prepared when it happens to make the biggest impact you can.
Dr Rhea Liang: And I think that's my biggest message to people, 'cause people get frustrated. They'll be like, "I really wanna make this change. I've spoken at so many committees. I've talked about it. No one's listening to me. I'm not getting buy-in." And you're like, you can't make it and you will burn yourself out kind of banging on the old brick wall.
Dr Rhea Liang: But, you know, keep working on it. Keep fostering those networks, finding your allies, developing the [01:09:00] resources, 'cause when it happens, it can happen really, really fast.
Sharee Johnson: Mm. Yeah, I think that building networks and community and s- and, and mentors and so on is really important, and it has me thinking about sponsorship as well.
Sharee Johnson: Do you feel- Mm ... like that's an important part of making things happen?
Dr Rhea Liang: Yeah. I'm, I'm using sponsorship in that sense of- Sort of, um, collegial or networking sponsorship, not in terms of coursework.
Sharee Johnson: Yes, that's what I mean too. That, you know, that you-
Dr Rhea Liang: Yeah ...
Sharee Johnson: you know, you're not at, at a meeting, but somebody says, "Oh, Rhea Liang would have something to add to this.
Sharee Johnson: We ought to go and talk to her." That's
Dr Rhea Liang: it.
Sharee Johnson: Or, or can- That's it ... can I nominate, I'd like to nominate somebody who I think is really relevant for this committee, that, that kind of stuff.
Dr Rhea Liang: Yes. Yes. Mm. So all the literature suggests that we are over-mentored but under-sponsored.
Sharee Johnson: Mm-hmm.
Dr Rhea Liang: So people will say, you know, "I am a mentor to indigenous students," or, "I am a mentor to LGBT," or whatever.
Dr Rhea Liang: And you're like, well, that's great, but all the literature we have suggests that the biggest benefit of mentorship seems to accrue to the mentor. You [01:10:00] know, it beats up their CV. Mm. And, you know, they get kudos from it.
Sharee Johnson: It's so interesting, Rhea, because lots and lots of people that I work with, I ask them, "Do you have a mentor?
Sharee Johnson: When did you last speak to them?" And they say, "Oh, yes, I've got a mentor," and they s- name the person. I say, "When did you last speak to them?" "Oh, 10 years ago." Yeah. It's, it's like imagined. It's not a Rheal thing. It's not-
Dr Rhea Liang: Yeah, yeah, yeah ...
Sharee Johnson: like doing it every single life. It
Dr Rhea Liang: is. It is. And so we need much... So, so we know that people are over-mentored but under-sponsored.
Dr Rhea Liang: And by sponsorship, we mean, you know, rather than just someone mentoring you, which is sort of like giving you advice about, you know, what to do and who to network with and all this, is actually going out there and flying your flag for you. You know, I can't do that speaking appointment, but can I suggest this person?
Dr Rhea Liang: Or, here's this award, I'd like to nominate someone for it. Or, you know, as I sometimes do, much to people's annoyance. You know, a paper came to me and I didn't have time to review it. This is peer review, you know, for academic purposes. Um, but you know, there was this thing that said, you know, can you nominate two other people who are in this [01:11:00] field?
Dr Rhea Liang: And I didn't have a ti- chance to ask you 'cause you were in theater, but, you know, look out for that email. Please say yes. I'm on it. Yeah. Please say yes. Please say yes. Yeah. And so you get people, you know, onto peer review boards from where you move into the editorial space. So that's how I found myself in the, uh, British Journal of Surgery editorial board.
Sharee Johnson: It's wonderful. Yeah. It's wonderful when it happens, I think. It's a step up from, uh, you know, like sometimes you get those introductory emails where somebody says, "I'd like you to meet so and so," which is also incredibly valuable and useful. I, I've... very grateful to people who have done that over my career for me.
Sharee Johnson: A, a step up from that is to say, you know, "I'd like you to meet so and so, and I think they'd be great for..." You know, it's really- Mm. .. really empowering- Mm ... isn't it? Mm. Yeah. Um, we're, we're running out of our, um, time together today. I wonder what sustains you, Rhea.
Dr Rhea Liang: Helping others. Yeah. I know that sounds trite, doesn't it?
Dr Rhea Liang: But it is that. Um- It's easy to come home from a day [01:12:00] in medicine and think, "I don't know if I achieved something." You know, I just pushed and pushed and pushed against the system, and I don't know that I achieved anything, and all the patients seem not to be ... You know, we've had some losses today and only a few wins, and gosh, you know, there was quite a lot of friction and conflict and the junior staff are getting terribly burnt out.
Dr Rhea Liang: And, you know, it's easy to get into that mind frame. Whereas if you sit down and think, "What was the good I actually did today?" And go, "I saved some lives," or, "I helped somebody," or, "I put a smile on someone's face," or, "I made a cup of tea for one of my nurses who looked absolutely knackered," you know, at the ward station or whatever.
Dr Rhea Liang: It's that generativity of being able to help others and deciding to focus on that, you know, even if it's a small thing. I don't think we Rhealize how impactful that can be, but having been the recipient of those small actions, I know how impactful it was. I remember there was a time I had, I'd had a bereavement in the family, and in the middle of a busy clinic, I, I just [01:13:00] found myself staring into blank space.
Dr Rhea Liang: It was almost like the grief had just descended on me like a big cloud, and I didn't feel I could see the next patient. And one of my most perceptive nurses, who I think Rhealized that I'd had my door closed for a good 20 minutes but there was no patient in there, you know, she was that clued into sort of the rhythm of it, just popped her head in with a, with a cup of tea ready made in her hand and said, "Oh, you know, I've got a cup of tea.
Dr Rhea Liang: Oh, do you wanna talk about something?" And she literally came in and we chatted, and it made all the difference. I could carry on after that. Mm. But she probably doesn't remember. To her, she's made a cup of tea and had a chat and tried probably to keep the clinic going 'cause, you know, the patients were building up.
Dr Rhea Liang: But those things are incredibly meaningful. I mean, okay, sometimes it might be the 16-hour operation or the, you know, breaking bad news done really well or, or, you know, the, the kind of really big heroic things. But we're in a very privileged space to [01:14:00] be able to help people with just small actions as well, and if we deliberately try and focus on that, I find that, myself anyway, a very sustaining practice.
Sharee Johnson: Mm. Yeah. Beautiful. Is there anything we've talked about today that you wanna go back to? I think there's hundreds of things we could have talked more about. I, I would like to talk more with you about the indigenous, doctors in surgery. Is there any small thing you can share with us about the progress or not about having more indigenous surgeons in our country?
Dr Rhea Liang: I've been thinking about this ever since. So when I arrived on the Gold Coast, I was the only woman general surgeon in public practice at least.
Sharee Johnson: In what year?
Dr Rhea Liang: Uh, 2007. Okay. And I think the next woman surgeon arrived about 10 years after that. So it was a long time to be the only woman in general surgery, but You know, you're sitting there thinking, you know, I have made it this [01:15:00] far, but I am being asked by people outside my specialty.
Dr Rhea Liang: Like I would get urologists asking me ... Because the urology, there was no female urologist. They'd ask me, you know, "Rhea, we've got an indigenous patient for whom the thing we're treating her for is women's business. So she will not come back and see us again. She will not have surgery with us.
Dr Rhea Liang: If we kind of talk you through a video through it or gave you a quick primer, do you think you could do it? 'Cause she really needs this care." And it was ... Uh, do you remember that moment in the Heart of Medicine conference when we had the, Akeyulerre (Akeyulerre Aboriginal Corporation) team with us, and I posed that to them and said, "You know, what's your advice for surgeons?"
Dr Rhea Liang: On a professional level, we're supposed to say no. Mm. We're supposed to say, "No, that is outside my specialty. I cannot do that." But I feel terrible that we do not have women surgeons or, even better, women indigenous surgeons who can [01:16:00] provide this care. And there was this awkward pause, and then they just said, "You just need more women in surgery."
Sharee Johnson: Yeah.
Dr Rhea Liang: It was inarguable, right?
Sharee Johnson: Mm.
Dr Rhea Liang: Yeah, and we need more women in surgery, and particularly more women indigenous surgeons. We have none. We, we have a small number of indigenous surgeons. They're all male.
Sharee Johnson: Mm.
Dr Rhea Liang: Mm. Oh, sorry. I should be a bit more accurate. Aboriginal. Yeah, so, so we've now got, I think, 28 Māori surgeons in both men and women.
Dr Rhea Liang: Um, so the New Zealanders are doing a lot better than us. But in Australia, we are well behind where we should be.
Sharee Johnson: Is something happening in New Zealand that we could be learning from?
Dr Rhea Liang: So they have had, um... I mean, every single one of the Māori surgeons is spectacular. You know, uh, I think they are excellence personified.
Dr Rhea Liang: But they've also had very good local support in New Zealand. When you go to New Zealand, you notice that Māori words are just used [01:17:00] in everyday language, that the street signs are bilingual. You know, it's just taken for granted, and I think that makes a big difference. So they have a specific, um, Māori surgical academy called T- Te Rau Poka or Te Poka Rau, I think, um, which takes promising junior Māori doctors and, and kind of gives them concrete support all the way through surgical selection and training.
Dr Rhea Liang: We probably need to do something like that.
Sharee Johnson: Mm.
Dr Rhea Liang: But we are beset. You know, every time you talk about it, people go, "Oh, that's an unfair advantage."
Sharee Johnson: Back to merit again
Dr Rhea Liang: It is, but it's like, do you not think that your ability to go to a private school or to know all these other, you know, white male surgeons or whatever, that is an unfair advantage.
Dr Rhea Liang: Mm. You know, my being a fourth year, fourth generation doctor, that was an unfair advantage, right? Mm. The world is full of these unfair advantages. Why should they not also have some?
Sharee Johnson: Mm.
Dr Rhea Liang: Yeah. There's such a pressing [01:18:00] need for it.
Sharee Johnson: Yes. Very, very pressing need. Okay. Anything that you want to tie a bow on, come back to?
Sharee Johnson: Are we, are we okay with our conversation coming to an end here?
Dr Rhea Liang: I don't know. I have a feeling like you and I and a cup of tea could keep going for hours and hours
Sharee Johnson: and hours. I'm sure. Do you have a mantra or anything that you say to yourself when times are tough or there's too much going on what do you say to yourself to to give yourself an anchor? How do you give yourself an anchor?
Dr Rhea Liang: So my little mantra for myself is, if it feels hard, it is hard.
Sharee Johnson: Mm-hmm.
Dr Rhea Liang: Yeah. You know. Yeah. That's a short way of saying, you know you can do this, Rhea. Like, you've distinguished your
Dr Rhea Liang: You know, you were, you got into medical school. You've performed on so many fronts. It's like, if you think this feels hard, then it is hard. You know, stop beating yourself up about it. Um, and I say that sometimes to my students. Um, or one of my bosses said it to me as well. He, when I was struggling once as a trainee, he goes, "You think what we do is easy?"
Dr Rhea Liang: Which [01:19:00] came across
Sharee Johnson: really- If it was easy, everybody would do it. Yeah
Dr Rhea Liang: Yeah, yeah. You know, which came across rather roughly, but essentially he was saying the same thing, you know. If, if it feels hard to you, then it is hard. You know? Yeah. Stop beating yourself up about it. Yeah. Yeah.
Sharee Johnson: Totally.
Dr Rhea Liang: Mm.
Sharee Johnson: Dr. Rhea Liang, it's been amazing to have you here for this conversation on Recalibrating with Sharee Johnson.
Sharee Johnson: Thank you for your time, for your wisdom, for all of the work that you're doing to continue to develop medicine and the way we think about medicine and health. I look forward to it whenever we meet again.
Dr Rhea Liang: Thank you for having me on, Sharee.
Sharee Johnson: My pleasure.
[01:20:00]
