Reclaiming Your Time with Dr. Sarah Smith

So always in medicine asked to do more, I've never ever heard, can you see less patients this week? Can you take more holidays this year? Can you not look after everybody's in baskets when they're away? Like, if we ever heard that being said to us.

Hi, everybody, and welcome to the podcast. This is Generations md. My name is Stephanie and I'm joined here by my colleague, Dr. Sarah Davis, who's also my mother. And today we have a very special guest, Dr. Sarah Smith. Dr. Smith, if you want to give yourself an introduction.

Hi. Yeah, I'm a family physician, just spent 12 years in Canada and recently relocated back to Australia. And I help physicians in the area of creating sustainability in their clinical day.

I didn't realize you went from being in Canada to Australia. So did you do your medical training in Canada?

Yes, I was born in Australia, did all my medical training here. And then when the kids were in their littles. But mid primary school, we traveled around Australia. Then we were looking for something different. So we went to Canada for a year and got to stay there a little longer. So 12 years later, we decided to move back to Australia. So that was a short, condensed version of the events.

Yeah. Just out of curiosity, what is the medical training like in Australia and do you know how it compares to. To the US.

So US May be different than the Canadian experience, and certainly I watch the Canadian medical students come through our community, so I have a little bit of an understanding that it can be similar in the US So medical school and then you apply for what you want to do when you are done, so your specialty training, and you go straight into that from medical school in Australia, it's different, and it's different than Canada as well. So Australia, you finish medical school, you go into the hospitals, and you do hospital rotations as an intern and then you can stay in the hospital system and be, you know, medical registrar or emergency department registrar or a career medical officer in emergency medicine, icu, medical, surgical, whatever you want to be. But if you choose that specialty, you then do your primary exams and you apply to that college then to continue in that path to become whatever it is that you're interested in. So. So there's not that same level of, oh, what am I going to do when I grow up? And so for myself, I knew I wanted to be rural, I knew I wanted to be a family doctor, but at the same time I wanted to have kids. So I stayed in the hospital system and did my critical care training prior to leaving the hospital system to do my general practice. Training because I had a little one. So I did that extra year of emergency plus another year of ICU emergency and anesthetics in order to finish that critical care training as part of my rural general practice and then moved out into the suburbs to be general practice training.

Yeah, I was just going to ask about exactly how rural are you and is that where you were originally from? Is that where you grew up? Tell us about that.

So we were a little bit nomadic as a growing up family. So I grew up with dad initially as a Baptist minister and then he moved into World Vision and then Arthritis foundation and then some other CEO roles prior to going into self business for himself. So we'd actually moved 14 times by the time I was 14. When I was. Yeah, when I was seven. We lived in remote Western Australia which was very, very small town, a mining town. So there was. That was grade two and three was very, very remote. So you would consider that one of the remote towns of Australia. But where I spent most of my time was in the city of Perth, Australia which is on the western side. That's where I completed my high school and did my university training. But I met my husband sometime in high school. We eventually got married when I was in fifth year medicine and had our first baby about 10 months later. And we wanted to go outside of the city. We preferred being in the country environments. And throughout my training the was ever a rural elective to be done or if I could do this particular training in a country or rural location, I preferred it because you just had that you were the only learner. You got to do all the fun things. There wasn't anybody else competing for what you were doing. So some things you had to do in the city like vascular surgery, but many of the things like emergency medicine you could do outside in the country environment. I then got a rural scholarship which took me to a country town for my internship and first two years which was on the other side of Australia. And as a married couple we were willing to do that and it supported me through medicine. So it gave me a bit of money for which was helpful because that then allowed us to find someone to look after small infant while I finished medical school. But then that moved us across Australia to the other side to Tamworth. Not a tiny country town like a hundred thousand people at the time, but it was an amazing experience because again there weren't a huge amount of learners but there were good solid learning opportunities. So we had nine ICU and emergency department staff specialists on site. We had an ICU High dependency unit retrieval medicine. So we had that ability to get the core training, but again, still with the emphasis on country. Where I am right now is between two country towns of about 10,000 people each. So I live in the middle of that on my 127 acres, so I'm 20 minutes from a town either side. And I do my general practice work in both of those towns right now with intention once we kind of settle in, because I just arrived here to go really remote again and do fun locum work out in the complete, teeny tiny towns where you just have that connection with the peoples there. And that's just such a joy to be able to provide medical services to communities that don't have that or to provide some holiday comfort for the doctors that are there.

Yeah, mom, you talk about your medical training a little bit and how important it was for you to go out into those rural communities because. And see that there's only, you know, a couple doctors there and they gotta do it all.

Yeah, I mean, I thought that that was. It's definitely fun as a. I went to medical school in Kansas and they. We, for one month, everybody had to go out to a little town in Kansas and work with a doctor out there. And, you know, people kind of said that they dreaded it, or some people did, or they didn' want to be like, locked away so far away from their friends and everything. But I think everybody really did enjoy it. You just got to do so much stuff that you just never get to do in the city with competing with so many other people, deliver babies and be suturing things up. And. Yeah, I think that the patients were always so fun too, because, you know, they'd come in and. And I'd say, well, I don't know, you know, I think you need to go to an ophthalmologist for this. And they're like, honey, if you don't do it, I'm going to do it myself. So just, you know, do your best. And you're just like, okay. And then you, you know, you just got to get it taken care of. But I do think, you know, one of the big disadvantages, of course, is not having enough doctors. So how does. How does that work for you? I mean, I guess you said you're doing locum, so you're kind of covering for people or tell us a little bit about that lifestyle.

Yeah, that's a great question. So during medical school, part of the scholarship that I had was as a second year medical student. I got to be placed in the Same country town for six years in a row for two weeks per year. There was a Royal Flying Doctor scholarship. So I went out to this teeny tiny town in Western Australia and stayed with the local doctor in his family home with his wife and children. And when he was on call, I was on call. Anything he did, I was his shadow for two weeks. And so that experience over those six years was so incredible for seeing exactly what it looks like to be a family doctor in a teeny tiny country town where you are it, you are doing your clinic during the day, you're also zipping down to the emergency department, department for, department for emergencies and the staff are rescheduling the patients because you're now caught there doing something interesting and in the middle of nowhere. So you're four hours from the closest CT scanner and you know, surgeon and all the things. So they did obstetrics there at the time because they had backup with a local anesthetist who could come. So they, they had their ways of doing that low risk obstetrics. But for me it was more looking at the whole of the environment and the family situation. So when I'm going into some small towns now, every town is going to be different with what's there. But it's the understanding that the team is the, is the people looking after the community and the doctors are feeling part of that need. So you might be the only doctor for 400km. That was my experience in Western Tasmania where I would call for help if I needed assistance with how do I do this or that or how do I, how do I retrieve this person in the middle of the night if needed and figuring all of those mechanical parts out as the doctor. But you're really relying on your nursing staff, your Aboriginal health workers or your other. Even the local secretary on the front desk who knows the patients really well, who knows if so and so doesn't turn up, that's a problem. That means something's happened, we need to go find that person or we need to go and ring this person because the only way they can get in is if Auntie goes and gets them. So that's really important as part of you, you're not a solo person when you're in these environments. The other thing that Queensland did really well, which I loved, is if you're in the emergency department and things are going down and you're the only doctor position, so there's things that you have to do potentially as part of that resuscitation and things that are going wrong, they have an eye on the sky. They have an eagle approach. They can turn on the cameras from Brisbane so you can ring the retrieval doctors and they turn on the cameras and they can look at what's going on in the trauma bay and they can be your counter. So they can say, two minutes has gone by, give more epi. And that's fantastic because that's just one less thing about the mental load of doing this. You can hold up the ECG and say, look at this. Tell me what's going on. They can look at it. They can zoom in, they can look at it. They can watch your monitor for your sats. If you're busy doing some other line, they can be very, very helpful. Even though you have that clinical courage of I'm it, how am I going to figure this out? Is also about that having your back about. I'll do my very best. I will know my limits and use my team and call for help and help will be available, and I'm helping be part of the mechanics of this community for this short period of time.

Wow, that's incredible. I love the idea of somebody looking down and giving you help. That seems so futuristic.

Yeah.

And it's something.

Yeah.

It's not like a lot of stuff in place to help support you, which I just like. That must be incredible.

Yeah, yeah. So the physicians that you're calling, when you're calling the retrieval service, they often understand where you are and what resources you have, because they've spoken to you or your colleague who's normally in this role multiple times. They may have even come out on a retrieval because I'll send the helicopter to come get you, and sometimes they're on the helicopter as part of the team that comes and picks up your person. Even in Canada, we had both the startings of being able to turn on the cameras in the trauma bay, but we always had the neonatal roll ability. So we had this computer on wheels with a camera attached, and we'd roll it into a neonatal resuscitation and they could watch and help, which is really good.

The other thing that I just have to mention, when you were talking about living with that doctor for two weeks.

I am so curious about this.

This is one of the things that we've talked about. Our reason for doing this podcast is that when people are choosing the specialty, we've said, you know, it would be great if you could shadow that doctor for 24 hours and see what their life is like. And you literally did that. So I think that's it.

Was an amazing opportunity. So it was a Royal Flying Doctor, had Raw Flying Doctor scholarship in Western Australia. And I applied for it because I knew I wanted to be a rural gp. Don't know. That just seemed to be the thing that was of most interest. I love variety and I love doing it all. And so this was an opportunity to be in exactly that. It's that immersion. You're part of the team and you're an important part of the team. If he's got a full clinic and he knows you because he's got to know you over years. I was the one who was sent up to the emergency department to get things started in my third year there, which is super cool. Especially when unconscious patient who's a known diabetic and you're not sure if it's because of high or low sugars and you're it. You're like the first with the nurse trying to figure it out, trying to get lines in and then you're ringing him going, okay, calm down, I need your help kind of thing. And he would like, of course, be there in a few minutes time. But it's that, wow, I get to have that opportunity to be the first on scene within the emergency department as the part of the medical team, which is an incredible experience. But also seeing him at the end of the day come home exhausted. So he's not, he's not keeping a front. He can't do that for two weeks. He has to show his true colors. So him interacting with the kids, finding out about their day, helping them with their school difficulties that they're having, you got to see four, sorry, six years of them growing up. He got to see me pregnant and then the next year with my kiddo. So my in laws came down and looked after my firstborn. And as part of my two weeks there, the final year, I was there. So I was a mom too, in that particular journey. And I still stayed in the house, but we had a hotel room not too far away for in laws and baby to be at.

That's incredible. Yeah.

I'm surprised that that didn't like discourage you from wanting to go down this path. Just seeing how hard it can be.

Well, it gave you a really good reality of what life could look like if you were the solo doctor in a town. Which certainly made for decision making in terms of what sort of town do we want to live in as a family. Right. His wife was part of the medical practice, so she did some of the bookings and front desk and back end bookkeeper work. So they were very immersed in this business together. Seeing them hire staff and fire staff and how they brought in another doctor and onboarded them. And then the transition as all the kids started to leave high school and then the changing that happens as you got this doctor who was really motivated, fired up, lots of energy and then you kind of get to the, oh, I've been doing this for a long time, I'm getting tired. All of that was visible to me. So I got to see that entire event happen unfold over six years. So it gave me a really good understanding of what does it take to be a family doctor. When I'm talking to these remote doctors, what is their experience like? And I can feel and know what, what they're going through in their day and, and all of the aspects. Where are the kids going to do high school? Are we going to stay in this town when the kids all leave? Like all of that decision making, you get to see small amounts of it after each visit. It's incredible experience. Yeah. It didn't put, but didn't put us off, but it made our decision making about where we would place ourselves as a couple. That made it a bit easier.

Yeah, yeah.

And I think that's so important to think about all of the other aspects of things.

Yeah, exactly.

Like, where are your kids going to go to school? What about this? I think a lot of times we get so stuck in the bubble of being like, okay, what do I want to do? What, what kind of pathology do I want to see on a day to day rather than kind of what do I want to create my life? Like, what do I want my life to look like? Can you talk a little bit about how you, how that experience and other experiences kind of helped you shape the life that you made today?

Yeah. So we lived in a small country town in Canada. There were 10,000 people in our catchment area. The town was a bit smaller than that. We worked in the emergency department, in the clinic, looking after inpatients, looking after long term care, doing palliative care, doing home visits. You go to Walmart and you get, hi Dr. Smith. Hi Dr. Smith. Hi Sarah. Oh, hey, did you get this and that in. So you having been modeled that within this scholarship because whenever you'd go to the store with your preceptor, he was known like every single person in town has seen him. So those boundaries of you can't have friends as patients didn't commute to me because in my world where I'd grown up within my medical training, your patients are Your friends, Your friends are your patients. So you doing a Pap smear on the one week and you're having a barbecue with them the next week, it's just part of life. It's just what you do. So you're kind of like the country doctor, the country vet. The medical community was bigger than the doctor. It was often the doctor, the vet and the dentist. Right. Because you're like, it wasn't just the doctors in these teeny tiny towns. But when I got to Canada, it was wonderful being able to do it all, because I really hadn't had that experience in Australia, where I'd been in a town that was just small enough that you were the doctor in the clinic, the emergency department and the hospital. Right. And so it was really nice to be able to combine all of those skills. But then I knew the patients when I was out in the community, I'm having barbecues with the people I've seen in the emergency department or in my clinical rooms. We were 15 doctors strong there when I moved there. So it wasn't that I was the only doctor by any, any stretch. And I could not have done it all. There was way too big a need for seeing doctors and having that access. We were looking after other towns as well as they lost doctors. So we had a lot of patients. So there's certainly. No, I meant it certainly was not the case, but it was certainly. When I'm down in Walmart, people would wave at you and initially the kids would be like, is that a patient? Is that a patient? Is that a patient? They're like, there's patients everywhere, like, and there is. And then they saw that as part of just how it is. And for me, it wasn't a problem. I'd go to Walmart in my daggy Saturday clothes. I wasn't going to put on a pretty face every time I had to go out. You just got me as is. And that was fine by me. I was very comfortable being Sarah to the community. Sarah in the office often. Dr. Smith was not necessarily the title I had everywhere. It didn't matter because that's not what I'd seen modeled ever.

Yeah.

Kind of transitioning into this charting business that you've made how I'm sure, like being one of the only doctors in the community definitely has an impact about the amount of work that you have to do. And I'm sure you have long hours, long days, plus now, plus then you have to chart as well. Can you talk a little bit about kind of the strain that. That Might have put on you and like, what. How you developed this business.

Yeah, sure. So part of being a family doctor is that you see patients and you have to do your notes, and then you have other things like referral letters and inboxes and things coming in. We've then added to that over the years with things like patient portals, email messages, et cetera. And I'm not blaming. I'm just saying my initial general practice mentors were male doctors. And that's not an issue. Right. I like male doctors. However, when I said to them, how do you do this paperwork thing? They said, oh, you come in on Sunday. Oh, okay. But that doesn't work for me because I've got little people at home. And when I said that, I didn't understand what I was asking for wasn't what they thought I meant. So they kind of meant the overflow of the inbox that might be left over when you come back from leave. Not my chart notes aren't done. So in the course of me seeing a patient, I would do that later because I'd rush into the next room or I'd go have a cup of coffee or I'd chat to my. It wasn't just that I had another patient waiting all the time, and that's the experience of a lot of doctors. But at the end of five years, and at that time, we didn't have remote access, so you had to come in on Saturday or Sunday. And so I would spend hours trying to finish off the work of the week. Hours and hours. And that's expensive in that I'm missing out on being a mum. So when after five years of doing this and I was in a place where we had a house I loved and a job I loved, I said to my husband, you know, I could give it all away and go traveling around Australia now rather than waiting till we retire. And he's like, really? You'd give it all up here? I'm like, yeah, yeah, I would. And I'm really not enjoying the burden of the evening and weekend work anyway. So privately to myself, in shame, thinking something's wrong with me because I can't figure this out. Sunday's not enough time. I'm still not done. And so if I'd. If I'd recognize what was happening and I potentially went and sat in with my mentors and watched them work, I may have seen them do things differently. But my experience was it was the consultation notes and the referrals and the inbox and the. Was accumulating for Sunday and they just did not seem to be accumulating to the same amount or it wasn't taking them as long. Then I came to Canada. So we traveled around Australia, had a great time doing locum work, doing emerge work, that sort of thing. We were like set at the end of a. It was a dead end road in a small country town for a year, doing a locum. So where are we going to go next? So we thought we'd go to Canada. I got to Canada and within a few months it had all started again. Seeing patients now I had remote access, going home late, helping the kids and husband with dinner, bedtimes, homework, and then back on my computer for hours, weekends, hours and hours of work. I was losing time with my family and my eldest kid. I got to grade 10 and I was still having the same problem. I'm never done. This doesn't end. How do I get this done? I don't know what to do. I'm stuck. I'm having to say no to barbecues. He's going to leave home in two years. This is not how I wanted it to be. And so that frustration for myself is where I went looking for my own answers. And I couldn't find anyone to do it for me. So I used a general life coach and her process of doing impossible things and failing a bunch of times till you get the exact result you want. And took 18 months to figure myself out. So I would see patients and I would be done at the end of the day. And that was an incredible transformation of change. I had bucket loads of time. I would leave after the last patient and I'd go home to a empty head. There wasn't an inbox waiting for me. It was done. And that was not easy. And it was so incredibly light to do my job again that I said, oh, I can't keep this to myself. I have to go tell my friends. Because it was coming up over and over on Facebook, groups and conversations with others. Watching your workmates either struggling in the office or going home to work was not pleasant to watch when you knew it was fixable. And so it was that process of, okay, I'm gonna have to go and teach the others. And that's what I wanted to do. So that's how it came about.

Yeah, I mean, I think that's so important to be able to identify what you're not liking about the job and trying to fix it to encourage sustainability. Because, you know, we talk about burnout and stuff a lot, but we all got into this because of Our interest in love for medicine. So it's. I think that's so admirable to be like, okay, I'm still enjoying my job, but there's these parts that I don't like, and let me find a way to fix it. Well.

And I also think having the courage to say, okay, I'm going to change my process. I'm going to do something different. I don't like the way it is because I think there's so many people that say, I don't like this. I don't like this. But then you say, well, okay, you know, are you willing to do the hard work and really try to figure out how to make those changes? And a lot of times they just. They don't. They don't want to change or they just can't really grasp that. So. Yeah. So tell us a little bit about, you know, how you. How you work with people and how do you change that mindset?

Yeah, it's starting with noticing. So just noticing, like you said, Stephanie, what is it about this that's frustrating me? What is it that's making me dread going to work? What is it that's giving me this heaviness about. Or what is it that's making me want to go open a bakery? Right. Rather than doing this job anymore? And then we feel like we've got no control over it. I can't control how many problems the patient brings in. I can't control where my lunch break is going to be. I can't control when the nurses have finally, you know, got the patient roomed and are ready for me. I can't control, you know, when I start work in the morning, I can't. There's a whole lot of obstacles that will come up immediately for you. And then it's the noticing. What do I have control over? How else do people do this? What else is available to me? Why is it that I take 18 minutes and somebody else takes 14 minutes? Why? What are they doing differently to me? And having that ability to get insight into the infinite possibilities of how we work within our day, and then choosing to practice something a little teeny tiny different, that could get some momentum towards what you want. So if you identify, like, what is it that I would prefer than this? Just know that there's an obstacle course to get there, and then how do we solve for those so we can get you closer. Even if you don't get the exact outcome you want, you're getting closer to what you prefer. So you might start having conversations with your staff. That says, hey, I noticed that my first patients in the room at 8:15, when the appointment supposed to start at 8. Can you tell me why? Can you tell me what happens in the morning that creates this? Is there any way we can help ourselves get closer to 8? Is it all right if I grab the patient and get started and you can have them afterwards? Even those stepping into conversations that are hard in order to just reflect on, hey, I noticed this and I'd like to get started on time because that has a compounding effect on my day. And I'm the one here till six. And you guys have all gone home at 4:30. Right. And then what's possible if they're like, no, you know, the, the earliest we're ever going to have a patient ready for you is 8:15. Stop. Having an 8 o' clock patient just stop. Or have that one as a phone call. Right. It doesn't have to be a person who's actually here in the office. You could potentially call them if you get paid for that. So it's that what is happening, why? What's possible?

Yeah. So often people think that they don't have control and they don't have. There's lots of things that you can't control, but there are things that you can. And focusing on that instead of the frustrations of the things that you can't control.

Yeah. Even that I hate my job. And that might be like. Or there might be a sentence that you're saying, I don't have time for that, I don't have time for that. That you're saying on repeat. And then I want you to notice, when do I laugh? When do I have fun? When do I enjoy this job? What is it that I like? So we can create a narrative about our day which is just on repeat. Often our brain is just going to tell us, I don't have time for that, I don't have time for that. And then we can start looking for evidence of what we are enjoying and what we do have time for and what we do spend time on. And it just creates the opposing argument for what you're experiencing as a reality. Knowing that that shift can be enough to get you started towards the momentum of what you want.

Yeah, I think that is so important. That's something that I, I think about a lot and I talk with my peers about just being in medical school. Sometimes there's kind of a rhetoric of just like, oh, this is terrible, this is awful. We are, we're, we're studying so much, we have to study so much. And I, I'm like, well, it's true if you say it all the time, but we have fun and we enjoy stuff. So I, yeah, it's, it's really hard to still maintain that mindset, especially if you're surrounded by people or if you have an experience where you're in a hospital setting and all of your colleagues are saying that same thing about how they don't have time and they're too busy and all of this stuff. It's. How do you help people kind of pull themselves out of that mindset?

Yeah, sometimes it can start with strategy. So we can say, okay, how long is this inbox going to take you today? If you did it in the way you normally do, just for the work that comes in today, not the big backlog, but the, the work of the day, how long is it going to take you and when can you do it? You may not get paid time to do it, but this kind of like study as well. Stephanie. So if you got, you got to learn kidney, how long do you want to set aside to learn renal? And then when can you do it? This week or today? What time slots are available for your use that are okay for you? And then if you turned up at your allocated time, say you've got eight till nine available. Make a plan ahead of time on where you'll start. Because the energy to get started can be used up in the where should I start, where should I start, where should I start Question. Okay, so that was one of the big shifts for me when it came to. Because I would get to the end of the day, my brain is completely destroyed in terms of my decision making. Fatigue. Right. You've made thousands of decisions. It's 5:30 and you just sit and look at it. You're just sitting and looking at it for the first half hour. You don't want to touch it. You'll do anything else. Right. You'd rather go clean the toilets in the clinic than look at this in basket because it just, it feels overwhelming. So it's that planning ahead of time. Where will I start? What chapter will I read first? Or will I start with the labs or the X rays or the letters? What's of most importance to me, what's the priority? And then that commitment, you absolutely know at 8 o' clock or 5, 10, you do not want to do this. This is not the fun part. Your brain will be looking for pleasure, avoiding pain, anything to escape. So that net negative will be compounded because you'll be sitting Playing on something instead of doing what you want to do. Then at the end of that time, you'll be mad at yourself and not doing it. Know that you'll be restless, irritable, mad, angry, whatever it's going to be that shows up for you when you do either the study or the in basket. And be there. So at 8 o'. Clock. Okay, I gotta go, I gotta go see. Have your computer open, have the labs open if that's where you're starting. And then it's top down or bottom up. No cherry picking. Everything has to get out of this in basket or this chapter has to be ready. So don't cherry pick. Just do what you said you would do. Knowing that you're going to feel restless, shame, irritability, frustrated, annoyed at yourself for not doing this earlier. Oh, this one's been sitting in my own basket for three weeks. I should have handled this before. It's that ability to say, okay, and even when I'm feeling tired, I can still tick off the first one and then the next one. And then asking yourself questions like, how can I make this fun? How can I make this easier? How can I make this take less time? How can I do this with less words? So always in medicine asked to do more, I've never ever heard, can you see less patience this week? Can you take more holidays this year? Can you not look after everybody's in baskets when they're away? Like, have we ever heard that being said to us? No. So know that we're always asked to do more. And so it is us that has to guard our time and how much is on our plate. And so it's that, when will I do this work? What is the priority so I don't have to turn up and say, where will I start? Because that's going to destroy my ability to get started. Know that I'm going to feel all the feelings and I'm going to commit to doing it anyway. I'm not going to yell at myself when I get half of it done. Because inevitably we look at 300 things and think that'll take us six and a half minutes. And we're curious why we're still there an hour and a half later. We're only halfway through. Oh, this takes me longer than I think it does. Yeah, we all have that time awareness issue. We want those magic wands that make us be able to absorb information immediately and make completely amazing decisions in fraction of a time.

Well, how did, after you kind of implemented these strategies, how did this shift your Life and particularly how did it shift?

Like being a mom.

Yeah. So I could say yes to the weekend activities. So much fun. Oh my gosh, we love adventuring, so give us a good hike. Kayaking, kayak, fishing, canoe trips, camping trips. It was. I got to say yes, and that was super cool. I got to come home and be part of the cooking of dinner and chatting about the day. I could sit on the couch and talk about university decisions that were being made and how things were going. I felt more present at home, so that was wonderful. In the work situation, nothing had changed in that we had the same emr, the same staff, the same number of patients. In fact, I could see more patients and still be done, which was amazing. We still had on call for the hospital, so I still had the full requirement in terms of the time in the clinical hours, but it was the downtime, the ability to rest, the ability to sleep all night, not have to get up and stay on the computer all night. Of course, then I added a business which creates a completely new set of ability to burn out, but in the space between. And it's another example of what are you saying yes to? And what is the time commitment of that? Right. So we're very good at saying yes to requests like, hey, we need someone who can mentor the students this year. Great, right? But what does it actually look like? Break it down into what are the hour commitments? What is the expectations of the role? If I say yes to this, what am I saying no to? Okay. Or if I say no to this, what am I saying yes to? And that's really important because as we say no in our clinical day, we can have all the guilt and shame, especially if it's a patient asking for this or that or an extra fit in patient or whatever. But that no can kind of override the I'm saying no because I've got a big yes to say yes to in the evening. So it's that negotiation of your finite time.

For sure. I think your whole story is really admirable. Especially just what stood out to me the most is the point of, you know, figuring out exactly what you're not liking about your job or whatever the thing is, and making some, making a big shift in your life rather than just saying, okay, I'm gonna quit, I don't like my job and I'm gonna walk away from it. Especially just the point that it, it was like your son was already in 10th grade and you could have walked away, you had the option to, but you knew that there was There was a part of you that still enjoyed this and still wanted to do it. So that's like really inspiring for me to hear especially and my peers at the beginning of my career knowing that like you can make shifts in your life, in your, the way that you're doing things, I guess. What other advice do you have for me as I'm kind of starting this journey towards medicine and any of my other peers that are kind of in different levels of the medical education as we're starting out and gonna go on?

Love that question. So good. So one, I was the sole income earner of our household because we'd made the decision early that husband wanted to be the stay at home dad. And that was an amazing opportunity for him and the kids, which was excellent. That meant I'm the one who's now earning the income and I had no other skill set at all. So while I might have wanted to open a bakery, that wasn't actually going to pay the bills and there wasn't anyone else. Well, husband had returned to work because the kids were now in high school. But it certainly was not the physician income. Right? So I didn't feel trapped. I actually wanted to be the income earner within my household. And I enjoyed that challenge and that role, but just it was another reason why I had to transform within rather than look external. For what else could I do? Yes, I could have totally escaped to a new continent, but I knew what, what happens, the problem just follows me because I'm the problem. Okay? So I had to change. As I was in medicine, that decision on what do I want to do? I guess the answer is you can reinvent yourself over and over. One of the best lessons I ever learned was as I wrapped up my practice before we traveled around Australia because I had a panel size 1500-2000 at that time, because I was full time general practice, not doing any emergency department work at all, those patients saw me out of preference. They could totally see the other doctors within the clinic. In the Australian environment, you're not solely able to see that doctor. But I had to say I am replaceable. I think that was the best lesson I learned. If you know that you are replaceable and if you fall off the planet or win lotto and go live in Brazil, whatever fun thing you want to do, your job will be advertised and someone else will take your place or your patients will go and find alternative ways to get healthcare. Okay. Because sometimes we can feel trapped in the decisions we've made. I spent all this money getting here I can't possibly do anything else. Nope, you get to reinvent yourself. So I reinvented myself from full time general practice. I went back to the emergency department to upskill bring out those old crusty critical care and emergency department skills so I could go around Australia and locum in emergency departments out of preference to general practice. And then I relocated to Canada where I was an international medical graduate. I didn't know the culture, all of the medical names were different. I had to do the whole clinic and hospital and emergency department reinvention. Okay. Now I relocated into also owning a business, business person. Right. And then again relocate back to Australia where I feel like I'm starting over as international medical graduate again because everything's different. I've forgotten all the names I've gotten, how to bill. I don't know who to refer to. And having to rely on my colleagues again, this is the hard. And I'm signing up for hard when I go remote and I don't know any of that either. And I'm relying on the people around me to help me transition in here. And I'm saying, yeah, let's do this. This is part of the adventure, the challenge that I, that I enjoy. But if you make a decision and you go down a path and you realize it's not for you, then you've got choice. Always you can say, is it me doing this job but I'm in the wrong location. Is it that I just feel like I've turned up and done what everybody else did and I need to step back and say, how do I want to show up in this role? But I'm staying here because we've got a lot of physicians who have been able to transform how they show up in their role. And suddenly it is for them and they're thriving rather than trying to do how everybody else was doing it and getting further and further behind or backlogged or staying six hours past their shift. Right. So it's the what's happening and then go get advice. There's enough people out there now. Don't hide it. I think that's the other thing. If we, if we keep it inside us, shame grows in the dark. And that's really. If you say I'm struggling but you don't say it out loud, it'll just grow and consume you. If you start bouncing it off a colleague and then they say, oh, you should go and talk to so and so. They really help me in that area. Go talk to that person. Keep following the trail of who are the right people to help me or, oh, yeah, I struggled with that too. And here's what I did. And you're like, oh, you struggled too. That's better than the information you gave me. I just needed to know that I'm not the only one that's part of that trauma informed care that we give each other when we say, you know what, Last week I had a terrible experience. I did this and I feel so bad about it. The patient might have been fine, but I'm taking that home and I can't sleep about it. As we share that, as we're vulnerable enough to share those experiences, others can say, yeah, me too. I'm so thankful you shared that because I'm dealing with this and it's making my head crazy. And we realize we're human and we start to connect in a way that helps us. Connection is so important. Don't be isolated. It's so easy to get isolated in medicine. Find your people who you can share with.

Percent I love your story and I love that message. So thank you so much for being here. Where can everybody find you and your coaching business? Any socials that you want to plug in?

Yeah, sure. So the podcast Sustainable Clinical Medicine is where I interview guests like you beautiful ladies. And then ChartingCoach CA is where you find out about the programs we run. Charting Champions and Smarter Charting program.

Yeah, amazing.

Great.

And you guys know where to find us. Generations MD on Instagram and TikTok. And if you have any questions, you can email us at Ask Generations.

And.

We will talk to you next week. Bye, guys.

Thanks. Bye.