Moyez Jiwa
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Moyez graduated from Trinity College Dublin (complete with an Irish accent), he trained as a family physician in Scotland, with postgraduate qualifications from Nottingham and Sheffield Universities , UK. He now works as the Associate Dean at the Melbourne Clinical School, University of Notre Dame Australia. He also sounds like a BBC newscaster, which is why he hosts the Health Design Podcast. Dr. Jiwa authored The Art of Doctoring, the book launch unfortunately coincided with the pandemic or you would have read it already. The book includes 30 years of research, some of which was reported in the world’s most widely read newspaper. He is the editor in chief of the Journal of Health Design and believes that we can change outcomes in healthcare today by focusing on how we communicate. He also believes that Italians make the best scooters and that they serve the best coffee in Melbourne
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Hi, everybody, it's Gustavo, the host of the Enabled Disabled podcast. Very quick description of myself. I am a middle aged Latin American male. I have dark brown hair, comb to the middle and I am wearing a black polo shirt. And I am absolutely delighted and thrilled to have Dr Moya Jiu on the show today. He is an Associate Dean and professor of Health Innovation at the Melbourne Clinical School at the University of Notre Dame. He is also a general practitioner, best selling author, The Art of Doctoring, which we're going to get into. And he is also the editor in Chief of the Journal of Health Design, which is a fantastic peer reviewed publication that is trying to talk about and highlight health innovations for better outcomes for patients. I love their two kind of mission statements. Is better health by design, small change, big difference. And we're going to talk about that and much more. Moyes, welcome to the show. Thank you so much for being here.
Thank you so much, Gustavo. I'm delighted to be here. So I'm moyes you as you describe. I'm a middle aged man of Indian extraction. I wear glasses today, I'm wearing a black sweatshirt and a jacket and I'm in my front room.
Fantastic. So, my first question for you today, you have just this wealth of experience and knowledge and you are one of the few doctors that I have met, along with PJ Miller, who I hold an incredibly high esteem, and that is pretty rare these days for doctors. So what brought you into the profession? Like, what drew you to becoming a doctor?
Well, I'd love to tell you there was a wonderful story about illness in the family and a desire to make a difference to those people, but that's not how it was in my generation. My generation went to medical school because you got the marks at school, you got the entry into medical school, and if you were bright enough, you were basically told, well, you are going to be a doctor. And at the age of 16 or 17, as I was when I went to medical school, that's exactly what I did. There was no grand plan, but it unfolded as I went through medical school, because in medical school, you could decide it wasn't for you. And many people did decide that at that time, in the 1980s. But I stuck with it. And what changed for me was the experience of seeing patients and experiencing healthcare first hand with the worms. I view what was going on and I realised that, in fact, I wanted to be an artist, but my art was going to be essentially, I was going to translate the science into an art and become that type of doctor.
When you were in residency and you started to interact with other doctors and see how they practised. My father was a physician in California at that time and you were in Australia correct. So the art of medicine was much different than it is today. Can you describe what a doctor, how they were seen, how they practised medicine, how they engaged with patients back then?
Yes. In fact, I was in the Republic of Ireland that was raised in Dublin, which is why I have this funny accent. For an Indian man at the time, I would say that medicine was a very reductionist. So it was very much that the doctor was seen as the expert and patients came along to consult the expert. There was no doctor Google, in fact, there wasn't even an internet at the time. And so we tended to be regarded as up on our high pedestals, giving out advice to people, being told by our mentors that we held the key to people's well being and that they were coming to consult us. And we were the guardians of that knowledge, all of that change into it.
So you were the guardians of their knowledge and their well being. What started to shift that or, erode that sense of guardianship and almost like a health advisor role. Right. What started to, erode, those roles and the way people saw themselves as doctors?
I'm not sure that they were eroded, particularly in the hospital sector. So when you're talking about specialists, and to an extent that still exists, in my view, but in family medicine, that definitely was beginning to change because we were not able to keep up with the rate at which science knowledge was expanding. So most of what I had learned in medical school was out of date within ten years of my qualifying. And so I recognised. As many of my colleagues did in primary care. That we needed to have a partnership with patients is the only way we could keep that momentum going. The momentum in our careers that we had set up. Essentially wanting to serve people. Wanting to be part of their lives and getting back a lot of the reward for becoming doctors. Which is that relationship between the patient and the physician. And what happened, essentially, was that in the NHS, in the British NHS, where I did my postgraduate training, where I became a physician, multidisciplinary care was very much the key to how the system operated. And so we were surrounded by nurses, by physiotherapists, occupational therapists, social workers and whatever else.
There was a big team of us that served the patient and we very quickly recognised. Those of us who entered primary care. That this was going to be the future. That we needed to share that knowledge and go into a partnership with patients who are now. Beginning by the 1919 and certainly by 2000. To know more in many cases. Particularly those with the air conditions. No more than we did. Based only on the knowledge that we had acquired in medical school. So it morphed into something quite different. The whole business of entering into medicine.
Interesting, it's interesting that you're focusing on the patient, the patient experience, the partnership with the patient. So for you, can you talk a little bit more about what that partnership means and what that partnership means to you in your practise and how you teach it to the up and coming physicians?
I think the thing that happens to most clinicians as they get older is that they begin to use healthcare themselves. And for me, the change happened when we had children. And I remember to this day calling out to our family doctor when our middle child had bronchiolitis. Now, I knew what bronchiolitis was and I could diagnose it and all the rest of it, but you cannot be a father and a physician at the same time. It just doesn't work. So we called this man out and I remember him being very grumpy, coming on a house, go to home and examining my little boy, handing me his stethoscope, saying, look, the child's got bronchialitis. Can you hear that? It's an extremely passive aggressive act. And I realised then that something was broken in the relationship between doctors and their patients. This was not going to be helpful to the situation that we were in. We needed reassurance, we needed him to play a very different role. And so it wasn't just at that point, but certainly that was a way marker for me to recognise that the relationship between doctors initially has got to change. And that even although we may have the answer as physicians or we may have the answer as patients to whatever it is that's ailing us, it is only in that partnership because whether you're a PhD or you clean homes for a living or whatever else you're doing that's more humble.
You'd say to yourself, well, I need the magic that happens when I enter that room with that position. And somehow it makes us feel better just because the interaction is of that nature.
This is true. And one of the things that I found very helpful about reading The Art of Doctoring is that you empathise with the patients and with the clinicians. And people who are outside of the medical profession don't often get to understand the pressures and the different influences that are going on in the background within that system that make your job so much more difficult than it already is. And I was able to empathise with the physicians for the first time because you were open to describe what's going on. So when you have 15 minutes with a patient that you've never seen before. And you know that the system is incentivizing you to give them a prescription or to send them to do a bunch of exams or whatever it is that the system has incentivised us to do. How are you able. As a practitioner. To stop and take control of your practise and design it in a way where you can reclaim some of that relationship and partnership with the patients.
I think it's really going back to location, it is going back to what I am getting over and above the financial reward for looking after my patients and why I do the job in the first place. And it is still true that people go into medicine because they care what seems to happen in the course of their training and certainly the trauma of the first few years of their career is that they burn out and they become cynical and that's an awful place to be because you then start to believe in your own drink. Your own koolaid and say well. I'm ordering this test why I'm prescribing this drug and that's what's making the difference to the patient and you become frustrated when that isn't the case. What delay public don't understand are the limitations of everything that we do in medicine. So to give you a simple example, if you look at the actual science, the number needed to treat in other words, the number of patients that are needed to treat for one person to benefit from whatever medicine you're prescribing is never one. You imagine that this drug given to one patient is going to change the trajectory of their illness.
That is simply not true. The number is often closer to 50 or 100 or 1000. In other words, if you prescribe this medication for 1000 people, one of them is going to benefit in the way that is described in the brochure for that drug. In the same way that the positive predictive value of a test here we're talking about pure science and there's no art here, this is science. The positive predictive value of a test depends on the prevalence of that condition in the community. So if something is really very common, the positive predictive value is quite high. In other words, if you have a positive test and you're looking for this very common condition, it is likely that the patient has that condition. In most cases that is not the case. The positive predictive value is very low. If you start from that point you realise that a lot of what you are doing actually has very little value benefit to the patient except for the situation where the patient has had a road traffic accident and you're trying to piece them together there the value is immense because you are actually saving a life.
But in all other cases, whether it's a chronic illness or it's an acute infection or whatever it happens to be or it's a depressive illness, your treatment actually contributes very little to the benefit to the patient. The real benefit to the patient is in the interaction and in how the patient feels after they leave your office. Even supposing the outcome is not brilliant. In other words, the patient doesn't do particularly well. The benefit to the patient is vast if the interaction is of a higher quality. And so whilst I'd love to say it was all about caring and wanting to be nice to people. This is pure science. If what you have to offer is very limited, there must be something else that you're offering that actually makes a difference in patient. And that is often what we gain in that room when there's only two zoom and it's a private conversation.
That's a very fascinating and unique perspective. Why do you think more doctors around the world don't come to that realisation if that's what the pure science tells us?
I'm not convinced that all doctors understand the science quite as clearly as that. If you think about how we train doctors and we train doctors to take a history, to do an examination and to make an assessment of the patient, it is not true in my view, that the doctors would necessarily have at their fingertips the number needed to treat the positive predictive value or understand the science in quite the same way. Medicine as a career is pretty overwhelming. The amount of information that cram into that experience. The training is huge. And often the people who are training doctors are not the best teachers because if you look at some of the better universities they are crammed full of researchers who are published in high impact journals, who are scientists and who have whole raft of other distractions to what they're offering their students. These are regarded as the best universities because of the way the thing is funded. So these people being employed by that institution are going to bring funds into that institution. They're going to be very attractive to international students because meet the Nobel Prize winner who discovered XYZ, who is a teacher at our university.
What you've got to ask yourself is does that translate into good teaching, good basic teaching, the kind of teaching where we're talking about the number needed to treat post predictive value, understanding what the interaction is all about. That does not get quite the same traction in med school in my view. And that's why I think we produced doctors who still to this day are reductionist in their view.
There's a lot of questions here. If we go back for a minute to the patient doctor interaction and you're saying that the science says that positive predictive value shows that you need to prescribe, for example, in one out of 1000 cases that drug is going to help them. And what's much more valuable is the interaction between you and I sitting in a room getting to know each other and the experience that I leave your clinic with. So you make the analogy in your book to the way other businesses function, which is brilliant, which is we are trying to create good client experiences. That's what's going to bring people back to do more business, to have a long term impact, to help people. It's amazing that that connection isn't made more often because it's common sense and it's imperative so if I were to go and have a consultation with you for 15 minutes, you would want me to leave that consultation feeling like I was heard, I was listened to. You want to get to know me in a little bit of a deeper way so that we start to develop a trust, we start develop a bond together where I feel good about coming into your office next time I have to go to the doctor, no doctor.
Julie is actually helping me with my health, with my wellbeing, as a human being, why wouldn't I want to go back there again? Pretty much. Does that capture what you're trying to achieve?
It is. And the reason that it is the way it is is because health care is a monopoly. Healthcare is a monopoly. You cannot just go to any doctor anywhere. There isn't a choice. Often we're stuck with the person that we normally go and see. And because of that, because of the insurance or other constraints, because of that, and because the number of doctors in the community is very limited, because it's an expense, an expensive resource to produce, then you are stuck with a situation where you are having to see the same person, even although you don't particularly enjoy the experience. Now, the reason that I would do it differently is setting aside the business and wanting to be a good businessman. And I hate the idea of healthcare being a business. As you know, I feel that it is morally repugnant that we are having to pay for health care and living because if you saw somebody suffering in the street, you are not going to say, I'm sorry, he doesn't have enough money. He can be paid, he would not walk away. But because they're hidden away in other people's homes, we simply feel and they can't afford it.
Too bad. I find that repugnant. Anyway, setting that aside, the reason that I cross the experience as I do is certainly for your benefit as a patient, but more important, in my view, and people are very like this it's for me, it's for what I get out of the interaction with seeing you. If you are coming to me and saying I like coming to see because it isn't like you're going to become a multimillionaire doing medicine. I think it is true now that if you want to be a millionaire, you need to not do medicine and you need to go into some it or some other field. So it's not the financial reward, it's the other reward. The other thing that we talked about, which is about vocation, it is about why we do what we do and the sort of people we bring into medicine, people who want to serve selflessly. And for them, the reward is very much built into the consultation. And those who don't get that reward burn out and very quickly become cynical, which is what we started this conversation.
But it's also really nice to see that in your Practise and what you're teaching is to say to the doctors, look, you can control this, you can design a better experience, you can build your Practise in a way that is rewarding on multiple levels for you and for your staff and your team. I know that whether or not it should be medicine is a business and you're still taking that entrepreneurial spirit there and you're saying, I'm going to make this better because it matters and here's how, and I applaud you for doing that. And whether the financial benefits come and whether I know that the other benefit is much more important. I would imagine that if you hold 1000 doctors and said, how much better would your life be as a physician if you got patients writing you thank you letters and coming back and thanking the staff and maybe buying the crew lunch, buying the team lunch because you're just so thankful for your experience? Of course it's going to make your work better. Of course you're going to feel better about what you do. That's human nature. We all do. We all love that.
The reason that I crafted or have framed it in the way that I framed it in terms of the value from the business perspective is because we need to speak to the people who could make a difference. And that's today's physicians. And it seems to me the one place that we all sit up and pay attention is when somebody says the rewards to you, including the financial rewards, will be so much greater. If you do it this way, suddenly your heart is open. What I'm hoping is that as people adopt these behaviours, adopt the art, adoptering, that it transforms their experience from I did this for the business to I'm now doing this for myself because I'm enjoying my interaction with my patients and it is no longer a chore to turn up on Monday morning and have twelve people in the standing between me and lunch, as it were.
Ask you or I want to tell you a quick story because I think this highlights a lot of what you're talking about. So I go to a physical therapist once a week. I started going to physical therapist because I had some nagging injuries which the three physicians I went to go see were not helpful with, and the physical therapists were extremely helpful. Once those injuries got healed, I approached them and said, look, can I come to you every week and can we establish this role? Almost like a physical trainer? You know my body better than anybody. You're not scared to work on my body and I would like to get stronger and fitter and better. And they agreed. So what happens? And I've seen this with their Practise with every single patient. The first thing they ask everybody when they walk through the door, how are you feeling? Followed by, did you get to do for me? Did you get to swim this week? How did your body feel in the pool? What did you notice? How have you been eating? How's it work? So I get to spend quality time with them on a weekly basis, and they know more about my body and how it works and where my weaknesses are than any physician I've ever seen in my life.
Wouldn't it be fantastic, though, if these physical therapists could communicate this information to a family care practitioner right. To break these silos that we have? You wrote a great paper on establishing a community of practise where the general doctors share better notes and better information when they refer people to specialists to get better outcomes. This also applies within the different health care fields, correct?
I don't and I want to ask you a question. Do you go to the same hairdresser? Do you go to the same barber?
I do.
Right. Why is that? Are there no other barbers in town?
There's plenty of other barbers in town.
Plenty of other barbers in town. What is it like going to see a barber?
I get to enjoy some good conversation. They know what I like and what I don't like, and it's overall a good experience.
I've learned to trust them, and that is the key. I think your physical therapist certainly could teach your family doctor something, but your barber could probably teach them more, because if you think about it, there are other barbers, probably better barbers, probably better qualifying barbers all over wherever you live, but you choose to go to one place, and I bet you even wait to see the same barber. If that barber is not on duty that day, you'll say, I'll come back. I'll come back tomorrow, and Fred's back. A lot of people do that, and there's a reason for it. And here is something that is critical to the art of doctrine. And a physical therapist in the barber have one thing in common. They lay their hands on you. And that's something that we have become very complacent about in medicine. So one of the things that I talk about in the art of doctoring is find a moment where you make physical contact with the patient, even if it is to cheque their pulse, even if it is to take their blood pressure. And before covert, it was, shake the patient's hand, please. Shake the patient's hand.
Now, we know that there are all kinds of issues with that now. And in Zoom culture, which we have now entered, the Terry health thing, it's become even more difficult. And so these interactions where somebody actually lays their hands on you and we are very tactile creatures, humans, these have become extraordinarily valuable interactions. You wouldn't, for example, ask your postman to touch you. You wouldn't expect your postman to touch you or your librarian or your barista at your local cafe those people who have the social right, where the socially acceptable to lay their hands on you are, you could actually count them on the fingers of one hand. They'll be your partner, they'll be your doctor, your barber, your physical therapist, your master, whoever it happens to be. There are very few people. Now imagine the amount of equity in that interaction. Now, I'm talking pure business here, the amount of equity in the fact that you're able to do that as a doctor. So two things your doctor needs to do in order to tomorrow revamp the experience. Number one is to shut up for the first two minutes of the interaction, not ask you who asked a lot of questions about your symptoms, just let you speak, how are you today, how things going?
And give you two minutes, even a minute, of silence, where they don't interrupt you in that pregnant pause and you will find yourself disclosing to your doctor something that is absolutely crucial. Because when humans interact and there's a silence, the person who breaks the silence often fills it with something that is really quite crucial in that interaction. It's something they didn't mean to say, but they say, but it's important for that other person to know. So next time you're with your partner, just say nothing for a minute and see what comes out. It'll surprise you that's the first thing and the second thing that the doctor can do is find an opportunity to lay their hands on you, whether it's to take your pulse, blood pressure, whether it is to examine you in some way, because that is going to add a huge amount of value to that interaction. And just those two things alone will change the nature of your encounter with the doctor.
What has happened? Why has that physical examination diminished?
Excellent question. And I bet you know the answer. The answer is to do with technology, because rather than examining your chest, I'll send you for a chest xray. Rather than doing examining your abdomen, I'll do a note sound of your abdomen. Rather than doing cranial nerve or full neurological examination, which, by the way, only takes five minutes. If you do it right, I'll send you for a Cat scan or a CD scan. And what has happened is that the business of doctoring is getting in the way of the art of doctoring, because all of that is generating income for the other organisations that are now associated with medicine. Radiology, radiography, the investigative sciences. Every time you have a blood draw or you have something else, it is putting money into somebody's pocket who is associated with the business of doctoring. And now it's got to the point where if the doctor doesn't order a test, you think you're being short changed. And that's very sad, because that has effectively, over the years, over the decades, eroded what medicine has done for people.
In their lives besides the human interaction right. That opportunity to examine somebody as a physician, which is an art form in and of itself. Even if the technology is helpful, I would imagine that there are still cases where doing that physical examination can rule out a test or can lead to perhaps prescribing a better test because you realise this isn't the issue, something else is going on. Is that still correct?
That is still correct. And to go back to my science lesson earlier, post the predictive value of the test, the positive predictive value of a test. So let's say you've got a cough. The positive predictive value of a chest xray is vastly increased when you find a physical sign in the person's chest and you put the two together. So you say, when I examine their chest, it was dull to percussion in the left base. And when I look at the chest xray, there is a sign on the chest xray that suggests that they've got a lower pneumonia. Now, that's not a particularly good example because a lower pneumonia will show up on the chest xray without the physical examination. But you get the point I'm trying to make that when you're looking for, let's say you've got lymph nodes somewhere. So you've got lymph nodes in the neck and you've got a chest x ray with a funny shadow on it. You then are the positive producer value of that test. Looking for lung cancer is so much higher because the two bits of information coming together make the prevalence of that condition higher and therefore the positive predictive value of the test higher.
It is simply good medicine to examine the patient. We don't teach that enough.
There is an art in a science to actually diagnosing what's going on that we're only getting one side of the equation right now, it seems like, which is the technical aspect. Go do the tests and then we'll figure it out and we'll read the test.
Correct. And the other thing to remember is when you've had that interaction and you feel better about the doctor and they come to talk to you about your choices, after the chest xray comes back and suggests that you have XYZ pathology, the interaction becomes much easier because you already have invested equity, social equity with that person. So when they say to you, look, establish, here are your options and here's the option that I would recommend, it's like your Barbara saying, Gustavo, let's cut you. Have you thought about changing that fringe a little bit? How about we do this right? You are more likely to accept that advice from your regular barber in whom you have an invested relationship, than some strange guy who decides he just wants to have fun and change the way you look.
This is very true. I want to dive a little bit deeper into this physical examination because, as you know, this podcast is telling better stories around disability and we haven't touched. On that subject yet. So one of the best physical examinations that I've had from a doctor was in Connecticut. He's still practising, and he has a disability himself. And so he gave me probably the most thorough physical examination and he said, do you know, have you ever been examined this way before? And this was 20 years ago, but I still remember it today as if it happened yesterday. Do you know, have you ever been examined this way before? No, I have not. And he said, do you know why? I said, no, please tell me. He said, Because a lot of doctors are afraid of you. They're afraid of your body, and they think they're going to hurt you. And I remember thinking, okay, he might be right. I hadn't thought of that before. And I think that there is an interesting there's many different ways that a doctor can approach disability. I know that from a scientific standpoint, the medical model of disability of there's something wrong with you, it's something defective, you're less than has been pretty prevalent.
But as a family practitioner, how do you approach your patients with a disability or chronic illness? How do you change the narrative around that approach and see them as a whole person.
With a great deal of respect and with the understanding that this is going to be a partnership? So you start off whatever your fear is, whether it's a fear of saying something or whether it's a fear of doing something, you share that with the patient and you say, look, I've not seen a case like this before, Gustavo. Please be reassured. However, let's do this together. Let's do this together. So you tell me what works for you. If I hurt you and I'm worried that I might, please tell me straight away and I will stop doing whatever it is. If I say something that would offend you, that offends you, please don't go away. Just tell me straight out. Look, Doctor, that's not the way I would ask that question. I would ask it in this way. You are my mentor as much as I am your guide. And let's agree that we're both going to come out of this conversation with homework. My homework is to find out what is the best possible treatment for you that I can discover, knowing the science as I do. And your job is to find others like you who are able to support you and guide you through this.
So patient advocates, if it happens to be some chronic illness, diabetes, heart disease, whatever happens to be there are lots of advocacy groups out there that can support you. So you do that? I do that. There are other things. We might end up having his homework. I might like you to change your diet in some way. I might ask you to take some pills. I might suggest that we have these tests so whilst you've got homework, you can also give me homework. You can say to me this is what I'd like you to do for me and that means that there's a fair exchange. It means that when you come back to see me, you know that not only is there social activity thing but you're going to have to give me back something that I've asked you for. And likewise you can expect me to have done my homework and found out the rare cause of this or the place that is the best possible treatment centre for the condition that we're talking about or how do we further investigate this particular problem that seems to be persisting and is showing up on my blood work.
Fantastic answer. When that disability or that condition becomes invisible, where we have our mutual friend from Unfixed Media, Kimberly Warner and people who have spent five years, ten years sometimes I've talked to people before they get the correct diagnosis. How does that shift? Because what I've heard from a lot of people, and I'm sure you have too, is nobody believes me because they can't see it and they can't feel it, touch it.
That to me is a set play. So you cannot respond to a situation like that on the hoof. You have to anticipate that this is going to happen. So you often find patients who come in and having seen a number of doctors or even not and say look, I have these symptoms and I've had these for x number of years or months or weeks, the last thing you want to suggest is it's all in your head. Because even if it was, even if this was part of their imagination, that's not going to help anybody saying it in that way and often that is not true. What I think in those situations is whatever is going on is very real and feels very real to this person and you do not have the right to diminish that for the patient. You do not have the right to invalidate the patient's experience and so you start from that point and you say whatever you're going to tell me, I will believe you because you're telling me this is true for you, so it's true for you. So let's start there and let's work through this together until either it goes away or it gets better or we come up with a name for this condition which we currently don't have.
And if you start a relationship on that footing it means that you're not afraid to keep going back to somebody even though they don't have the answer because you know that in their heart they believe you, that this is how.
You feel that's powerful. As a family practitioner, when you refer someone to a specialist, should it still be your role or would you like it to be your role to still oversee, to talk to that specialist, to consult with the patient afterwards to see if there's better alternatives. What does that dynamic look like in a good medical practise?
In a good family practise? Essentially, the partnership is between the family doctor and the patient. Everybody else is extraneous to that because you cannot be sure how that specialist is going to manage that case and how that patient is going to feel at the end of that interaction, because we often don't know our specialist colleagues particularly well, particularly in the rare disease or chronic disease community. You're sending people to specialists that are only a name on a page with a whole lot of postnomials. They are FRCP and they got this and the other thing and they're a professor or associate professor at some institution and you're referring them there. You don't know what the interaction is going to be like or whether that patient will end up seeing a registrar or a junior doctor who has not got the expertise to assist that patient at that time. So you do not devolve the care of that patient to somebody else. You say to them, they are there to assist me, to make sense of what it is that you're going through and whatever it is that they're going to offer you. I am going to be there, even though I may only pay a bit part in a lot of that, but I will still be there in case something happens where your faith in that person has been reduced to the point where you want me to step in.
It goes back to the idea of being a partner and being a guide, a wellness guide that's really overseeing the health journey of a person as they go through life.
Correct. And also taking control of what we can control. I cannot control what happens in specialist clinics. I cannot control the way healthcare is responding to people in other places, or whether the reductionist view with farming industries take over and influencing things in a way that I would be uncomfortable about. The only thing I get to choose when I walk into my office is the colour of my tie and my attitude.
Thank you for that. It's very powerful. It's very refreshing for some. Go ahead.
Sorry, I was going to say this is not an unusual view. There are many, many of our doctors who take this view. I don't want to pretend that there's something completely different about the way that I practise my medicine. You've heard of people like Eric Last, who is a family doctor in Long Island that I have many encounters with. I am convinced that he has the same view. Dave Sharpener is another one that I've spoken to. These are all US based doctors. Gary Rogers, here in Australia, there are many others who take the view that it is a partnership and that what matters most is that 15 minutes that you spend, that precious 15 minutes, and how that unfolds in time.
Thank you for pointing that out. And I don't mean to. It's refreshing to me because I don't hear it often. And that's something that it's a reminder as a patient, the next time I go to either research a doctor or start asking people like you that I've met for maybe some recommendations or some ideas, it's important for me to remember that, and I think all of us to remember that there are really good physicians out there. We need to continue to look and continue to do our homework and continue to believe that we can find the people who share similar values as you do. What advice do you have then, for patients when they are going to see a family physician? What is it that they should look for? What kind of attitude should they bring to the consultation when they're going to see somebody to hopefully get a better experience?
I think it's to be clear about what you want that interaction to be like. If you want that interaction not to be a reductionist view making you feel like walking pathology like a specimen for the lab, then be clear what you want and do not be afraid to vote with your feet if you find that interaction is not the way you want it to be. There is potential harm that can be done to somebody if they are continuing to see somebody who doesn't meet their needs. You work with your feet. There are people out there. Talk to your patient advocates. Find out who has responded to the patients, to their fellow patients with respect and with this openness to be a partner and seek them out, there will be many of them wherever you happen to live, it's just a case of finding them.
Thank you for that. Is there something that I have missed in this conversation that you feel is important to talk about?
I wanted to go back to our mutual friend, Kimberly Warner. So Kimberly Warner and I created a course for medical students called Course in Clinical Confidence. And the course essentially allows junior doctors, medical students, to do some soul searching armed only with an iPhone and a friend. So with an iPhone, they can film themselves consulting with a friend. And they've got scenarios. The friend and the doctor medical student have a scenario they're not aware of. And they can observe themselves doing a consult and doing all the things I've talked about in this conversation. Being present. Being aware of what they're like when they're distracted. Being aware when they are judging somebody before they even open their mouths. And doing it in the safety of that consultation. As opposed to live when harm can be done to people. And we're trying to roll this out to medical schools and junior doctors all over the world. It's free to access. We'd be really pleased if that could be part of this narrative, so that if anyone out there is listening and would like to promote this to their medical school, their junior doctors, we'd be very happy to have that happen.
This is not an ad for anything. This is something that we've produced because we want people to experience this for themselves rather than listen to a podcast and go, that's interesting, I'll try that. Or maybe not. I don't know how that would work for me. Here's a real life way to do it for yourself.
That's very powerful and very needed, and I will help make some introductions offline that, can hopefully help that process. I think that you are such an accomplished human being and I don't know how you make the time to do all of the things that you do, but what I can say is that it is a testament to how much you care and how much power you have. And we all have as human beings to make change in small steps, and we are underestimating how much change we can make in small doses and within the spheres of influence that we have. And even if those spheres of influence are one person, five people, ten people, if we start to do it and we continue to do it, those fears will grow over time. And I think it's just a beautiful thing to see that you've embraced that and you're living that as well, and you're helping so many people by doing so.
Thank you very much for saying, I wish I could see it in that way. In the sense that for me, every single day, the things that I do, it's like eating chocolate all day, and the best of Belgian chocolate at that. It doesn't feel like work. And I think that's the secret, that if you find that you're doing something that no longer feels like work, it feels like you're playing, it feels like you're just doing what feels natural to you. And you're lucky enough as I am, and I do not underestimate that. To have the resource and the time to do it, then that's how we can make a difference in people's lives. Do the one thing that you enjoy doing and keep on doing that, and the rest of it becomes fairly straightforward.
That's Sage advice. Thank you. How can people reach out to you, get to know you better and engage?
Well, like you, I've got a podcast. It's called Health Design Podcast. And the value of that is that you hear from other people who similarly have a journey through healthcare and have insights in health care, often as patients, which is really very helpful and insightful because it helps us to pivot where we have to pivot. So the Health Design Podcast is one place and the editor of the channel helps. We are very much open for business. It is free to publish and free to access. And again, as a patient or as a clinician, you may have an insight. You might think, when I put a pot plant on my desk it somehow seems to change the interaction with my patients. Well, write about it. Write a patient inside or collision inside piece and say, I'm not talking about a randomised clinical trial, but here is my pot plant. And people notice it and it makes people feel better. I know that Kimberly Warner talks a lot about thought plants, so I thought I'd put that in as a plug. The other place is if you want to reach out to weird, we do have a group on LinkedIn called Patient Physician Advocacy Alliance that is very much open to anyone who has an interest in this kind of interaction and exploring this and who wants to think about, with a group of us, how we can make a difference today to change the outcome for patients.
Then we'd be delighted to have them on that group.
Fantastic. I am so thankful for your generosity of spirit, for your insights today, for taking the time to be here. This has been a fantastic episode. Thank you. Thank you, Moyez. I so appreciate this.
It's a joy speaking with you, as well as a joy speaking to you on my podcast. Keep on doing what you're doing. You are making a difference right across the world. Thank you.
Thank you. Bye.
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