30. A Leader in Breast Cancer Care

October 26, 2020 00:52:37
30. A Leader in Breast Cancer Care
The Culture of Leadership
30. A Leader in Breast Cancer Care
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Hosted By

Brendan Rogers

Show Notes

  If you didn’t already know, October is Breast Cancer Awareness Month. With this in mind, there is nobody better to have on today's episode than one of the leading breast cancer surgeons in Australia, Dr Lucia Saliba. Luci, as she prefers to be called, is trained and accredited in Australia as a General Surgeon with a broad expertise in breast and general surgery including breast reconstruction. She graduated from the University of NSW in 1995 and went on to complete her General Surgery Fellowship in 2003. In 2005, Luci completed her Breast and Endocrine Fellowship with the Royal Australasian College of Surgeons. She has trained extensively, both locally and overseas in areas related to Breast Reconstruction, Breast Oncoplastics and Breast Cancer Therapy. She has also recently completed her Master of Surgery (Breast Cancer). Luci has a passion for education, teaching and supervising junior medical staff and surgical registrars in the fields of Breast and General Surgery. She is committed to excellence in surgery and providing holistic and compassionate care to patients in a timely fashion, endeavouring to ensure minimal wait times. Luci provides end to end care for patients, meaning a patient is able to stay with her from oncological surgery, through to re-construction. Many other surgeons do not offer the ‘before and after’ of looking after a patient; they only perform the surgery. Luci will look after the patient from beginning to end, from testing to rehabilitation. The focus of our conversation is gaining a perspective on culture, leadership and teamwork as a surgeon.   A Leader in Breast Cancer Care   If you have any questions for Brendan around this episode or generally around culture, leadership or teamwork, feel free to contact him here.
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Episode Transcript

Speaker 0 00:00:03 Welcome to the culture of things podcast with Brendan Rogers. This is a podcast where we culture leadership and teamwork, business. Hello everybody. I'm Brendan Rogers, the host of the culture of things podcast. This is episode 30. If you didn't already know, October is breast cancer awareness month with this in mind, there's nobody better to have on today's episode than one of the leading breast cancer surgeons in Australia, dr. Lou SIA, Saliba, Lucy, as your prefers to be called is trained and accredited in Australia as a general surgeon with a broad expertise in breast and general surgery, including breast reconstruction. She graduated from the university of new South Wales in 1995 and went on to complete her general surgery fellowship in 2003 in 2005, Lucy completed her breast and endocrine fellowship with the Royal Australasian college of surgeons. She's trained extensively, both locally and overseas in areas related to breast reconstruction, breast Encore, plastics, and breast cancer therapy. Speaker 0 00:01:15 She's also recently completed her master of surgery, breast cancer. Lucy has a passion for education teaching and supervising junior medical staff and surgical registrars in the fields of breast and general surgery. Lucy is committed to excellence in surgery and providing holistic and compassionate care to patients in a timely fashion endeavoring to ensure minimal wait times. She provides end to end care for patients. Meaning a patient is able to stay with her from oncological surgery through to reconstruction. Many other surgeons do not offer the before and after of looking after a patient. The focus of our conversation is gaining a perspective on culture, leadership and teamwork as a surgeon, Lucy, welcome to the culture things podcast. Speaker 1 00:02:00 Thanks, Brendan. Thank you for having me. Speaker 0 00:02:02 It's an absolute pleasure, Lucy. I want to ask you a question we're going to dive straight in, but the most important question I need to ask you is why in medicine, do we use such big words that I find difficult to understand? Speaker 1 00:02:16 We do that so that you think we're very, very smart and really clever? Well, really the tree sees that medicine like anything else, any other profession has its language. And we use our language to be able to communicate with each other. So other medical practitioners and because we all speak the same language, we can pretty much understand each other from all over the world. As people in any profession will know, being able to communicate is very important. And in our profession, it's super important because it can impact somebody's life if there is miscommunication. So it is really just a way for us to communicate clearly and without sort of ambiguity between each other. When it comes down to communicating with patients, though doctors have to become skilled in speaking in plain terms so that everyone can understand for me, that's been not too difficult proposition because I come from a non-English speaking background and a nonmedical family. So, um, very often having to explain what I do in very plain terms. So yeah, that's why we speak in big words. Speaker 0 00:03:28 Thank you very much for that explanation, Lucy, from what you share with me before, when you were about three years old, you wanted to be in medicine. Do you remember back that far and sort of, what was it that gave you this inquisitive nature and the curiosity about wanting to be in this profession? Speaker 1 00:03:46 I'm not sure, but I did tell my mom at about the age of three or four that, um, I was going to become a doctor one day and I got quite upset with her because she had bought my brother one of those doctors toy kits and she hadn't bought me one. So I told her that, you know, this was a waste of time because I was actually going to become a doctor. When I grew up. I have no idea where it came from. We have no doctors in the family. We had a very nice GP, but apart from that, there was really no other influence. And during my childhood and teenage years, I was glued to the TV watching mash or any medical show that came on with extreme fascination. So I think that's pretty much where it started from, Speaker 0 00:04:30 You mentioned mash a famous shows. So you now get to wear the white coat. Speaker 1 00:04:36 Uh, we don't have the white coats anymore, but we wear our theater gear and gowns over the top and now hats and shoe covers. And yeah, so we have a different uniform, which is all about keeping clean and avoiding infection. Speaker 0 00:04:52 Just want to touch on that question as well around curiosity, because you've mentioned that before, when we spoken and, and just that insatiable appetite for curiosity, and being curious about subjects and, and that's how you best learn. So do you want to tell us a little bit about what you think drove that passion and that curiosity, and what's taken you into this journey of being a leading expert in your profession? Speaker 1 00:05:14 I think my curiosity and passion for learning comes from a very young age and it's largely influenced by my parents. Both of whom didn't have the opportunity to be educated in their country. So when we migrated to this country, uh, they brought that curiosity and passion for learning and gave it to us as well. Pass it onto us. We often would have discussions at home about various current affairs and different countries. Dad bought us a, you know, the old encyclopedia fits and I'm sure every family has on their book cupboard. And we used to watch shows like 60 minutes where we would discuss world affairs and things like that. And we were to ask questions. We would often write to the encyclopedias to look something up about various country. And so it was always, you know, in our home. And, and I think that's where my curiosity for learning started at school. I was also lucky enough to be encouraged by very good teachers. So I felt rewarded for having a curiosity for wanting to learn in medicine. I've always, I am to give the best treatment possible to my patients. So that would often drive me to want to learn more and to be able to, to give those good outcomes. Speaker 0 00:06:35 Can you also just tell us, give us a bit of framing around the journey involved in the education behind doing what you do because you don't just walk into a medical profession after a couple of years, it's a really long process. Can you give us a bit of background of how that works? Speaker 1 00:06:51 Yeah. It is a long process and it is one that requires commitment and resilience and being able to stick to something. So it starts with leaving high school, getting into university into medicine these days. It's more complicated again, where there are both undergraduate degrees and post-graduate degrees where you might have to do another degree. First, once you've finished your six years of undergraduate or four years, plus another degree of postgraduate medicine, you can become an intern, which is just about the most fun you can have because you now have a license to be a doctor and you get paid for doing not very much, uh, intense work with a lot of work, but you get paid. And that's the first time that was good, fun that lasts about a year. And then you become a resident in the hospital system. At that time, you get a feel for what field of medicine you might want to go into. Speaker 1 00:07:49 And that a lot of people will branch off either into the medical fields like cardiology or general medicine or general practice, or in my case, it was into surgery. And there are many different branches of surgery that you can choose from. Once you've done, a couple of years of, of residency then can apply for a training scheme. The general surgical training scheme is roughly four years long. At the end of that scheme, there is an exit exam that you do. And for most trainees, once they've passed their exam, they will go on to do further years of post-fellowship training. Um, and that may be in a subspecialty. So in my case, it was breast surgery and endocrine surgery. And that for me was two years of formal training. And then a further couple of years of informal training and in some reconstructive surgery, while I started to work as a consultant, so many years is invested in getting to a consultant position. Well, as said, that takes a lot Speaker 0 00:08:56 Of commitment and dedication. And I imagine there'd be some really good parts of that journey, but some, probably some tough parts. And often we talk about that. Why like, why do we do what we do? Have you got some clarity around that for you? What sort of took you through the, the real challenges in that journey? Speaker 1 00:09:12 Your ride times can be very challenging, long hours you're working plus you're, you're trying to study and learn as much as you can along the way. So it can be quite challenging from time to time. You ha you do you write, you have to have a why for me it's it was all about wanting to help people initially, but wanting to be the best doctor I could be to provide the best care. And that was, I've always taken responsibility all the way through from even when I was an intern, right, the way through all of my training to now being a consultant. So it wasn't much of a transition for me, but that being able to help somebody at the worst time in their life, for me, it's about helping them to get through a challenging time, to get back to having a fulfilling a normal life, as much as possible. It's a privilege to be able to help somebody through that and to see them get better. But I developed such strong relationships with my patients that I continue to see them for many years often, I'm considered part of their family, which is an absolute honor and privilege, I guess, all that drives you, but really being able to, to help people through a difficult time and feeling that you've made a difference is what drives me most. Speaker 0 00:10:32 Alicia, I think all of us nowadays on port, you have been touched by cancer, not Messi directly, but in our families. When you talk about that term best care, what does that best care scenario look like for you? And how do you deliver on that? Speaker 1 00:10:46 The best kit scenario is a multifactorial things. So I provide really one part of that care from initial communication, initial diagnosis explaining and allowing the patient to understand what is happening with them. My personal part is to provide the surgical treatment where necessary. And for me, it's part of a much more holistic approach in cancer therapy. We work as part of a multidisciplinary team. So there would be an expert providing each part of that treatment. So I would be the expert providing the surgical treatment. There would be another expert providing the medical oncology or chemotherapy or medical treatment, another expert providing radiation oncology, if it's needed and further experts providing things like psychology physio-therapy we have clinical nurse consultants who also add to that whole multidisciplinary team approach for me, see myself as one of the team leaders, because I will continue to see that patients throughout not only their care, but their recovery and then to violence moving forward. And for each patient is different. It's different, what surgery they require, what treatment they will require, you know, it's, um, it's not a cookbook approach. It's a very much, each person is a different person and needs different things. Speaker 0 00:12:17 You mentioned, you're a team leader. You see yourself as a team leader. Let, let's start to talk about that from a teamwork perspective. And what do you see as your responsibilities as that team leader in that best care process? Speaker 1 00:12:29 My responsibility is to firstly coordinate their treatment. So sort of a broad coordination of giving the patients a timeline, letting them understand what to expect. Moving forward with respect to my own area, which is the surgical management. I'm a team leader of my team, which starts in my office. So I laid my, uh, reception staff and they help to provide a smooth transition between all of the different aspects of treatment in the hospital itself. As a surgeon, you know, I work with a team, I have an anesthetist and I work with nurses trainees and we have medical students visit our theater. We have interns visit our theater. We have nursing students also there. So as a team leader, I'm there to make sure that the best outcomes occur by making sure that all of us safety standards are followed. But also that we have a generally calm, well functioning theater, where everybody is attending to their duties, but also doing it in a very calm and professional manner, which adds to the outcome in terms of the team. I see myself as helping to create that environment. And I've learned through mistakes and challenges along the way, about how to best approach and create that in the team. I have a learning approach where everybody is allowed to ask questions and learn and give their opinions, that whole adds to the final outcome for the patient. Speaker 0 00:14:06 And I definitely want to get into some of those mistakes and challenges. You know, we all love to hear about that sort of stuff, but let's, let's take a walk into the theater, so to speak. Can you just give us a little bit of a description around you as that team lady, you helping someone on the, on the theater table and prepping for surgery. What's that teamwork aspect of, of yourself and an anesthetist and the nurses and things in there. What does that look like? Speaker 1 00:14:31 We're all sort of parts of a process or a machine. We've all got our own little bit that we need to do. And it needs to just is taking care of the patient's vital signs and breathing and giving them the anesthetic that they need that allows us to do our surgery. The surgical team helps from the smallest things like positioning the patient to shaving off bits of hair that we don't need checking. It's the correct patient checking. We're doing the correct side. So there's a lot of checking that goes on before we even put knife to skin. It also involves communicating with our nursing staff, making sure we've got all the equipment that we need, that the equipment's working, all of that is happening kind of simultaneously. So it looks a little bit like organized chaos, but everything is happening for a reason at the beginning of my seat, at least. Speaker 1 00:15:20 So I usually stop have a look at the list of patients that we're operating on and we go through them and just make sure that we've got everything that we need. And we do that as a team. Uh, we call that a timeout. Some people call that a huddle where we're basically looking just to make sure that we are going to be able to run smoothly during the course of the day. All of that adds to patient safety. So everybody knows what we're doing. Everybody knows the rough timeline. We factor in tea breaks and lunch breaks. And if there are relieving staff available and that sort of thing. So all of that all kind of almost looks like it takes place at the same time in the surgery itself. I will generally, if I'm teaching than a registrar may be operating, but I'll take be taking them through step-by-step. Speaker 1 00:16:06 I do have requirements that they have to follow before they are that to operate. And that involves displaying that they've read up a little bit about the surgery, reviewed their anatomy, and can have a bit of a discussion about what we're doing. If I'm operating, then the registrars will be asking me questions or I'll be talking through the steps as I'm doing it. So it's a very interactive environment. I also like to keep it calm and pleasant. So we do have music playing. Every surgeon is different. Some surgeons like complete quiet, some surgeons that might a bit of noise. We have a bit of cheddar going on and, but our focus is always that patient. Speaker 0 00:16:46 And I'll have to ask, I want to keep a bit of lightness about this, but is there a favorite song that you've got, or the team's got that you played during surgery? Speaker 1 00:16:55 Well, it depends on I'm a little bit moody with my music, but I don't mind R and B and I like Motown. One of my nieces knows that if I'm getting stressed, he plays a particular song, which lightens it up, which is eye of the tiger, which kind of gets me, gives me a kick going and gets me back into focus. And, you know, my music tastes change. We have anything from classical music to ACDC, depending on what we're, what we're doing. Yeah. So it can vary. But the rest of the team, the nursing staff and the junior staff are allowed to bring their music in as well. And if I don't like it, I'll tell them. So Speaker 0 00:17:30 It's really interesting to hear how, I guess you lighten up the mood and in a pretty serious situation, that leads me into those challenges that you may be referred to earlier high pressure environment. And if you can believe what you see on these hospital, television shows, you know, there's stuff that may go wrong during a surgery and there's extreme pressure happening. So what sort of challenges do you have? What sort of behavioral challenge do you see within the team when those sort of things do happen? Speaker 1 00:17:55 Look, they do happen. Thankfully they don't happen too often because the surgeons were often control freak. So we try and control every aspect, but look, they do happen and people respond to that kind of stress in different ways. You know, I have to say something I'm not particularly proud of. In my younger days, I would tend to get quite stressed and with some people quite angry or just not coping with that stress. So over time, I've had to learn how to cope with that stress, particularly if you know, it would happen. If I, if I thought that nobody was sort of paying attention to me or paying attention to the surgery. So that was in my much younger days. And I think that was all about more to do with my feeling of not being able to control that situation in time. That is not an issue. Speaker 1 00:18:43 And I have many surgeons, we will have almost a routine of how to control a situation if it gets out of hand. So simple things like letting the rest of the room know that there's something not right and asking the chatter to be stopped. Sometimes I'll ask for the music to be turned off so we can all focus. I'll tell the nature just what's happened so they can prepare in case it is something serious and, uh, doing simple things like, um, changing the lighting or getting a better retractor or just repositioning things can sometimes be all that it takes to regain control. It's just about having a way in your mind. It's like you would do, you know, take 10 breaths before answering somebody is upsetting you. We would do, let's go through this sequence of points that you can, you can do to sort of calm yourself in that stressful situation. But yes, it can get really hearing sometimes particularly if you're operating in a trauma situation or a difficult cancer situation, you can come across that. But thankfully that doesn't happen too much for me these days. So a much more controlled surgery. Yeah. Speaker 0 00:19:54 Let me relate this to sport. First of all, you know, I play football, I try and play football, I should say, and you're talking a 90 minute match. So you sort of gotta be on for 90 minutes. If you relate that to what you do in these surgeries, I imagine go on for hours and hours and hours. How can you stay so focused on how do you and your team stay so focused in order to do the best job you can cause let's face it it's life and death situation. Speaker 1 00:20:19 Well, most surgeries don't go for too long, but we do have some of the reconstructive ones in particular that can go for quite a few hours, sometimes up to six hours or more hours, even longer, depending on the difficulties of the case. My approach is to break it up into three hour or four hour slots on I'm quite mindful of the team and my assistance as well. So we will often break meaning the table asleep, slaving the patient, sorry, it's on the table with the, um, with the anesthetist or a nurse watching them while we go off and have a toilet break or a drink, or to clear our heads. And then we will come back to it because it is difficult to keep focused. Also, as I said before, we have, we are try and do things within those to make the mood a little bit lighter because it's, uh, that tends to step in a D as well, if we're having too serious at times. So we, uh, do play music. Would you chat a little bit? We talk about other things, although we're completely focused on the sort of more routine parts of the surgery, we might crack a joke or have a chat about something, but, um, we have ways of breaking that tension, which can help with focus as well. I'm mindful of the other team players as well. So, you know, all the team, uh, encouraged to tell me if they're tired or they need a break or, or whatever. So we have that ability to stop at any time. Speaker 0 00:21:48 Do you always get to pick your team? The full surgery team is in there with you? Speaker 1 00:21:54 No, no. It's very rare in that public system that you get to pick your team. Sometimes particularly the older surgeons have been around a long time. They may be able to, to have a particular scrub sister that that is always with them, or, but for most of us know, we have to, we have to be able to adapt to having different team members each time, for example, with our trainee registrars, who are our assistants, and here we also teach, we have a different one every six months or so. So we only have them with us for six months during that time they learn what they can from us. And then they move on to another rotation. In terms of nursing staff, we have different nurses and you will have people of different levels of experience as well. So it can be, sometimes it can get quite frustrating, like in any job you're having a bad day. Things are not going as smoothly as you'd like. And you're having to sort of relate to people you've not either worked with before, who don't know you and you have to have ways of managing that. Speaker 0 00:23:00 Can you maybe talk to that a little bit because why this is so fascinating to me is that, you know, we, we talk so much about trust in teams and that, that is just such a foundation of high performing teams. And you guys have to be high-performing, but you're just saying that you don't always get to pick your team. So how do you develop that level of trust? How does that just come together to be this team that does such a great job for the patient? Speaker 1 00:23:24 Look, I think we're dealing with a bunch of professionals. First of all, and the trust comes from firstly respecting their expertise and where they're at trust also comes from knowing with that other person is at, in terms of experience. So if I know I've got a nurse working with me, who's fairly and is new, then I know that I'm going to have to approach that operation a little bit differently, where I'm going to have to spell things out and be specific in what I want. Whereas if I have a nurse who's more experienced than she may be able to follow the operation without much instruction and help us along the way, giving us the instruments that we need and things like that. Obviously, if you've got a team that you've worked with before, trust is a given, but I think trust can be formed fairly quickly, firstly, by you as a team leader, showing that you're trustworthy, that you're capable, that they can trust you in this situation. And very often I find that the rest of the team will give you their best and you'll be able to trust them as the day goes on. If it's in a very new team, obviously you will get people that are not team players or are not good in that particular situation. And you just have to learn to work around them. And what I find there is the other team members tend to take up the Slack. Speaker 0 00:24:48 What does a, can I say a non-team player look like in your environment? Speaker 1 00:24:55 Yeah, there's a few of them. Um, I think it's usually the person who either is not interested, not prepared, not wanting to be there. And they're pretty obvious, you know, they will stick out in most surgical teams in their theater because most, most of the time people are not like that. Often those people will often have themselves, a little bit of a reputation. So you know what you're getting on the day and in the past. So they've been a challenge for me to work with where we've had clashes of personalities or not communicating properly, not understanding each other. So in such a, an intense team, like a surgical team, they will stand out quite obviously, but often use their knowledge is often missing or their attitude is not good. They tend not to last too long in the operating theaters. Those kinds of people that will find a place for themselves somewhere else. Speaker 0 00:25:54 Well, I have to say it's a little bit scary to think again, that the sort of work that you and your colleagues are doing, that there's people that may have that sort of mentality. But I guess at the end of the day, it's a professional, it's a, it's a job for some. So it doesn't necessarily mean it's different to other jobs. Speaker 1 00:26:08 No, it's very similar to other jobs, except I think where, you know, I've been lucky in that the vast majority of people I've worked with have been very professional and committed. And as I said, the ones that don't want to be there, that it's not their world. And it is a very, as I said, a very intense, stressful environment that for some people they cannot cope in that environment and they will move on and we have that across the range of, of jobs. So they could be nursing staff that we've had registrars or trainees who have decided it's not for them surgery for some people sounds like a great idea until they get into that cave. And then it's not such a good idea. Speaker 0 00:26:47 You are a leader in your field off the back of this teamwork stuff that we've just extensively spoken about when you are leading a team where that non ideal team player is about. How have you learned to manage that as a leader in your own development? Speaker 1 00:27:03 If it's a, a trainee where, um, I feel directly responsible for them, then I do try and identify what the issues are with them and try and work through the issues with them. And most cases that I've come across, it hasn't been a lasting issue. And that person has usually improved where it's been a person where there've been a lot of problems, whether their attitude or skills or knowledge are not up to the standard that we would expect, and they're not willing to improve or change. I have had difficulty in that situation. And often I will either call on my senior colleagues for some help in sorting them out or finding ways to manage them in that situation for the time that we have them so that they get to some sort of direction. And in very rare cases where I've really had issues, I've had to separate myself in that situation. Speaker 1 00:28:06 But, uh, it can be quite challenging. You know, I've had to training to have come with a pre-existing reputation. And I find that with a bit of guidance there, excellent. And, uh, go on to become very good doctors. And there are, there are some that timing might not be right for them and some where it's not the right specialty for them, or yeah, so we, we do have challenging issues. And again, we approach that as a team as well. So in whatever hospital I've been, it's, it's never comes down to one person to, to manage performance issues. It becomes a team issue. We have directors of training. We have term supervisors, we have a sort of multi pronged approach to these kinds of challenges. Speaker 0 00:28:54 We said in the introduction, how you also spend a lot of time in the training side of thing with registrars and things. Now you're training the next generation. What's that looking like for us? You know, you hear a lot of things in all sorts of industries about this next generation and what they're like and all that sort of stuff. And, you know, we don't want to tarnish everyone with the same brush, but what are the challenges you're seeing for the next generation coming through, given that you're a coach, you're a leader in training people? Speaker 1 00:29:21 Look, I think their training is a little bit different to the training that we went through. There's been emphasis more on their wellbeing and things like safe work hours have been brought in our college. The college of surgeons is very proactive in terms of managing issues such as, and harassment and that's created, although a bit better working environment in general, it has created some challenges in terms of training. And it has meant that for many of us may include it having to adjust or change the way that we might train people or any particular speak to them or guide them or criticize them. So as not to be seen as sort of bullying in any way. So we've become more mindful of that. I certainly have had to do that. I'm pretty much a straight talker. And for some trainees that may be perceived as being inappropriate or pushy or bullying or whatever. Speaker 1 00:30:24 So I think that has had an impact on how they are trained for most registrars though. I'm pleased to say that they want to learn. They hardworking. They put in a lot of effort and are responsible for their learning. And they take that on board. We do have some that are challenged and have problems and they're usually counseled, but for some of my colleagues, engaging in teaching has become so much of a challenge that some of them have given up teaching or even up positions in public hospitals or things like that. So we all have had to change. But I think in terms of the public's perception, I think that the future of medicine is safe. It's just that we've had to learn to do things in a different way. Speaker 0 00:31:14 Yeah. And I imagine it would be a very, very fine line again, given the precious situations you're in and those behaviors under pressure that sometimes you just need to say something and it might not always come out or seem to come out in the right way, but there's context behind that. That would be a very fine line into how people can perceive things. And particularly, again, going back to that point where you don't get to choose your teams, so people don't really know each other. So there's that, not that really high level of vulnerability based trust that we talk about. There's a level of technical base trust because you're all professionals and stuff that must be quite a fine line to walk. Speaker 1 00:31:49 Yes, that is, it is a fine line. And I guess it comes down to perception at the end of the day. And your intention may be one thing, but the way your actions or your words are perceived can be another thing definitely that can lead to misunderstandings complaints, lots of satisfaction in the work place and all sorts of things. So that perception is really, really important. And sometimes you can't do anything about it. And as you say, when we're in a pressure situation where there is an emergency happening, or there is an issue, and you're focused on the job at hand, which may be a life-threatening situation, you sometimes forget about the niceties of being polite or things like that. They can go, that can get impacted. Most people you would hope though, would be able to understand the context of what's happening at that point in time. And I appreciate the seriousness and not take anything personally. And certainly the good trainees that are there to learn will understand the situation and see how they can help and what they can learn from it. Speaker 0 00:32:55 Lucy, with the registrars, those coming through that you're coaching and training. Are there any red flags that you see in your own experience where you think, Oh, this person might be, need some lots of guidance or maybe this is just not for them. What are those red flags that you see? Speaker 1 00:33:12 Yeah, most of the red flags have to do with, with attitudes. So how they interact, not only with myself, but how they interact with nursing staff in particular. So we have had situations where some registrars have behaved poorly towards nursing staff or to myself. We hear about all of these. So I do where possible take those registrars aside and have a chat to them about more appropriate ways of behaving patients will report on the registrars as well when they come and see me after their surgeries and tell me what their experience was like in the hospital. And that will give me a report on my team. Very often other red flags are to do with either poor organization or not preparing for cases and surgery. So those things often can be managed fairly easily by helping somebody to organize their time or organize their study so they can get more out of the whole interaction with the patients and in theater. And so that the learning experience is better for them most registrars when spoken to or guided real, take that advice on board and will improve. Thankfully some will not die and need sort of further guidance, which is, you know, we tend to give that more as a team effort. So that that team thing comes into play again, where other surgeons in the team would also be involved Speaker 0 00:34:42 As a team. Again, you've talked a lot about the team and then your broader team. And you're leading that. How often do you debrief situations? So whether it be surgery or whether it's a patient's needs, whoever, what does that look like in your industry? Speaker 1 00:34:54 So that the debrief process can happen in a number of situations? So the first one would be where something clearly goes wrong, where there's been an injury to a patient or a complication in that situation, we often will, once the patient is treated and out of danger, we will usually start that debrief process almost immediately as the case finishes, certainly with my registrars when that's occurred. The purpose of that is for us to talk through, what's gone on, see if there's any preventable factors, work out how to do things better next time, but also so that everyone involved can feel that the burden of that case has borne by everyone. I don't know how to explain that better so that no one person would feel responsible in that situation for anything that's happened. We all, as a team would work together and take that all on board. Speaker 1 00:35:52 So we all improve. I never want a trainee of mine to leave the theater feeling like, you know, it's all their fault or something has happened because it's their fault because that's not constructive. And you're not likely to learn in that situation if you're feeling hopeless or guilty or whatever. So I try not to play a blame game. It's just what's happened. And we all kind of will learn from it. Most registrars will find that very helpful. And I've been lucky in that most of my registrars, uh, with the exception of maybe one, most of them have taken some responsibility for what's going on. If they've been involved and they've taken that patient on as their own. So they've become more involved in that patient's care, following them up more closely talking to the patient, providing open disclosure, telling them what's happened. So we find that debriefing process can help a lot for that registrar to work through what's happened. We have other debriefing situations where every month or two, we discuss all of the cases that have gone through a unit. And we discuss the cases where there have been complications or problems so that all the surgical team meaning all of the surgeons, all of the trainees get to learn from each case, which I find very useful because it's not necessary for us to make every mistake to learn from it. We can learn from others as well. So yeah, debriefing is very important Speaker 0 00:37:31 Off the back of that question. I want to move us into this culture in medicine, in the environment you work in, because you know that culture of no blame and debriefing is really important, but in organizational environments. So I guess we call it office politics. Is there such a thing as hospital politics? Speaker 1 00:37:47 Oh, there is there's politics in everything. And, uh, in medicine it can be quite complex. It can be quite simple. I'm not a good one to be playing politics. And anybody who knows me will laugh when they hear me say that because they know I'm not good at it, but it's about sometimes playing the game, learning to get on with people I was, can be good in pushing forward the needs of a particular unit or surgical team. It can also be seen in some lights to be not so good in terms of where kind of obstruct the progress of a team or a particular surgeon. I have seen professional jealousies occur, people controlling situations to suit their own needs or their own skillset. So there is hospital politics, but thankfully for mostly it, these days is not so prevalent, but you know, like any, any corporate structure you will see you'll see politics. And unfortunately we do, we all have to learn to play these political games to get on in the workplace. As I said, I'm not so good at it because I tend to say what I think. So Speaker 0 00:38:59 Does that get you in trouble sometimes? Speaker 1 00:39:01 Oh yeah. Quite often. Quite often. One of the learning things in my life I think is to, uh, to not always blow it out, what I think would to find a softer way sometimes of saying something. So Speaker 0 00:39:19 It's a really good point in that, I guess your own self-development and self-awareness what have you done to bring yourself to become more aware of that so that you just, it's not that you hold back on what you need to say, but you just maybe check yourself to say it in a different way that people are going to hear it in the way that you want them to hear it. Speaker 1 00:39:37 Yeah, correct. And it looks a lot of it comes from having made lots and lots of mistakes in my life, in terms of communication. I have a fiery temper and having to learn to control what comes out of my mouth sometimes has been a good learning process for me to be honest, but I am very passionate about what I do and I'm passionate about patient care. And sometimes if I see something not being done correctly or not being done to a correct standard, then I might say something quite strong about that these days I still have the same passion for patient care. And my only priority has always been remains payer patient care. But I have learned to just step back and take a few deep breaths and possibly reword what I'm about to say into a, a nicer, more gentle way. If I feel I can't do it, then I wait. Speaker 1 00:40:39 I'll actually collect my thoughts a little bit better and then approach that person or that situation a little bit later, that way I find I'm not letting off a bomb in the middle of the room and having all this collateral damage that can sometimes happen when you just let yourself go on checked. But I find this sort of more temperate controlled approach does seem to resolve an issue a little bit more satisfactorily than what my old approach would do. So, yeah, I think this is about, I've had to reflect a lot on that kind of behavior and although it comes from a good place and my intention is good. I have had to remind myself that I am doing with other professionals and other people and they may not see my intention. They might just see my display of anger and therefore the message is lost. I'm not setting you up Speaker 0 00:41:34 With this question, but in that self-awareness piece, it just fascinates me because we're all a bit the same. We've got many weaknesses. I understand that I've got more than enough, just ask my wife, but in an environment that you're in. And again, those behaviors under pressure, I imagine that that awareness falters from time to time, Speaker 1 00:41:53 For sure it does, we are human. I can be the queen of the one-liner and, uh, I can, I'm very quick to answer, but I think maybe because I'm a bit older, I think, and I tend to choose my, I think I decide at the time, whether it's a fight I need to have, or whether it's something that needs to be said at that point in time. I think what I've realized is sometimes just going off and just saying something or losing my temper, it's not going to make the situation any better. It's going to add to more stress and more anxiety and within that situation. So it's also a realization that possibly that behavior did not have the outcome that I wanted and didn't improve the situation. So learning that that would not work. Sure. There are times when, you know, uh, the F bomb goes or something else because it is, uh, is required. But thankfully that's rare. Speaker 0 00:42:59 Thank you for sharing me. I'm going to stop that subject. Now. I'm going to take you off the hook. Absolutely. Absolutely. I'm not trying to, I want to just ask you around. You've mentioned that focus on the best patient care. A number of times you could have done that in multitude of spheres across the medical space. What is it about the breast cancer side of the thing that drove you into that area of passion? Speaker 1 00:43:24 Initially? I think I wanted to do, I thought back in my, when I was an intern that I wanted to do plastic surgery because I have a creative side and I thought that that would be pretty cool. Everybody wanted to do that. And as time went on in my training, I got to do a breast surgery term and I was lucky to work with some of the most eminent surgeons in that field. And I developed a passion, I think at that time for actually helping patients with breast cancer. What I find is that I have a, obviously a natural ability to communicate with other women, being a woman myself. I can understand the impact that having breast cancer can have on a woman's emotional wellbeing. So that drew me to that. The other thing about breast surgery is particularly with the reconstructive surgery that I've learned over the time. Speaker 1 00:44:26 It's allowed me to work in that creative field as well, where I reconstruct or help to produce a cosmetically more appropriate or beautiful breast for a patient with breast cancer. My aim at the end is that I leave as little impact on their life as possible in terms of physical deformity. You know, I, I don't want them to look in the mirror every day and think, Oh my gosh, I'm a cancer survivor. You know, I'd want them to look in the mirror every day and say, Oh, I've beaten this. And I've got to get on with my life as normal. So the cancer side became more of a passion and then, but that creative drive didn't go away. And I actually considered going back and doing plastic surgery training. However later in my training and in my fellowship, I discovered that they were doing things quite differently overseas, where a single surgeon or single team could approach both the cancer side of it, as well as the reconstructive side in the same team or same doctor could address both issues. Speaker 1 00:45:31 And that really appealed to me. And that's when I started in this world of oncoplastic surgery that involved getting further training, mainly overseas as there wasn't any training at the time here in Australia. However, I'm very happy to report that in Australia, we have an excellent training program now for breast oncoplastic surgery for the current trainees going through and that's throughout college. So that's been very good to watch develop over time. But for me, it's very rewarding to see somebody go through this and then come out the other end, healthy and happy and getting on with their life, Speaker 0 00:46:14 With the work you do. I normally ask people, what sort of advice would you give leaders around this and that, whatever I want to ask you, what sort of impact are you wanting to have on the world with the work that you do? Speaker 1 00:46:25 Well, I think firstly, I'd like to improve the lives of people who have to go through this disease and at least give them back or help to give back their sense of self as well as a sense of wellness so that they can go back into life and contribute to life and to their family and to the community as best they can in any way that they want to. In terms of teaching, I'd like to have an impact. There I'd like people to learn. My train needs to learn from my mistakes. So they don't make them themselves. I'd like to give them a belief that this is a great profession, that this is something that you can be proud of, that you can contribute to the world and you can contribute to other people's lives. Also, I think for my registrars are I'd like them to know that the learning doesn't stop, that our training, our surgical fellowship is really just a license to keep learning and to keep growing and to keep helping. So I hope that they would pick that up as well, that the learning part of it never actually ends Speaker 0 00:47:36 Lucy with that. I know you're a very, very busy lady. I know you've got surgery again in the morning and stuff. So thanks for giving up your time tonight. How can we get hold of you if somebody wanted to just drop you a line and just say, thank you very much for sharing. Speaker 1 00:47:47 Oh, look, they could pop onto, I think we have a website technically terrible. I wouldn't say, I think we do. You can contact us there. And at our website you can call our rooms, which is the numbers on the website. But yeah. Happy to hear from anybody. Speaker 0 00:48:03 Well, I can confirm you do have a website. It's dr. Dr. Lucy is saliva.com.edu. Absolute pleasure. I definitely need to know. I guess I've got a website Speaker 1 00:48:18 I'm terrified of computers most of the time. So, um, yeah. I have a great team that looks after that, Speaker 0 00:48:24 But we'll look Lucy, you can't be great at everything. So look what I want to, I just want to say thank you very much for giving up your time. Fantastic. Really massive. Congratulations on the work you're doing. It's been a pleasure talking to you and thanks for being a guest on the cultural things podcast. Speaker 1 00:48:40 Thanks, Brendan. Thank you. Speaker 0 00:48:52 As I said at the start of the show, October is breast cancer awareness month. It was such a privilege to speak with Lucy who is one of the leading pressed cancer surgeons in Australia. A big shout out to my good friend, Andrew Peyton Smith from <inaudible> who helped arrange this opportunity. I think you will agree. Lucy is amazing. Her humility, passion, and self-awareness shown through in the conversation. Her commitment to patient care is of the utmost importance to her. And the impact she is having is enormous. Every day, she is improving the lives of people who have to go through breast cancer. She's giving people a sense of self and a sense of remaining a valuable member of the community. Lucy is training the next generation of surgeons, helping them to learn from her mistakes and giving them a purpose and belief that they are contributing to society. Speaker 0 00:49:45 She's also teaching the next generation that the learning never stops. Lucy is demonstrating true leadership every single day. These were my three key takeaways from my conversation with Lucy. My first key takeaway leaders have a relentless drive for improvement. Lucy said it herself. She wants to be the best doctor so she can provide the best care to do this. You have to always be curious and keen to learn it. Also, wasn't just about her own improvement. She has in place specific debriefs, allowing the team to learn and improve together. This drive for helps ensure the best care for patients. My second key takeaway leaders show humility. This virtue was evident in Lucy throughout the conversation. Most people know humility as not being egotistical and braggy. The less common understanding of humility is that you also understand your own strengths and weaknesses. You know what you're good at and what you aren't. Speaker 0 00:50:53 Lucy shared on several occasions, her strengths, and was also humble enough to share her weaknesses. Humility and leaders is a key foundational virtue. Humble leaders thrive leading teams and may thrive being in teams. My third key takeaway high-performing teams contain individuals who are clear on their role and responsibilities. Lucy said it best when she stated we are all part of a process in the surgery team. Every single team member knows their role and what they are responsible for. And everyone else on the team knows what each other person's role and responsibilities are. This provides clear lines of accountability, which always leads to better results. So in summary, my three key takeaways were leaders have a relentless drive for improvement leaders, show humility. High-performing teams contain individuals who are clear on their role and responsibilities. If you have any questions or feedback about this episode, please feel free to send me a [email protected] Thank you for listening. Stay safe until next time. Speaker 2 00:52:11 Thank you for listening to the culture things podcast with Brendan Rogers, please visit Brendan rogers.com to access the show notes. If you love the culture things podcast, please subscribe, rate, and give a review on Apple podcast and remember healthy culture is your competitive advantage.

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