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Improving Your Digital Bedside Manner

This post first appeared in the Issue #1 of a new print and digital magazine called Telemedicine.

I was approached by the magazine’s editors who were seeking writers with a professional interest in digital health and telemedicine. I pitched them a couple of editorial ideas and this post was accepted and printed in their inaugural magazine.

telemed front cover

As with any innovation, there will always be the early adopters and the laggards. One of the first fields to embrace telemedicine has been behavioral and mental health. Mental health care is particularly well suited to telemedicine because of the cost benefits, its potential to improve access to specialist care and the relative ease of delivering care over a computer.

Being an early adopter has allowed telemental health to develop research and evidence-based practices that can be extrapolated to other fields that may be newer to telemedicine. Here are a few of the things they’ve learned over the years.

The Art of the Video

Providers should be constantly aware of how they present over a video link. The physical separation inherent to telemedicine can be bridged or widened based on the richness of audio and visuals, and on non-verbal cues such as vocal tone, quality, gesture, eye contact and facial expressions.

It is therefore important that providers be as comfortable and confident as possible when providing care via telemedicine technologies. A lack of comfort and confidence on the provider’s part can negatively impact and erode a patient’s trust, satisfaction levels and adherence to treatment recommendations. The literature on the use of telemedicine in psychiatry encourages clinicians to consider increasing their energy levels and expressiveness slightly to help overcome any feelings of distance or remoteness that might result from using videoconferencing.

Providers need to recognize that telemedicine is a two-way street, not a forum for the provider to talk while the patient passively listens. Allow time for psychosocial interactions and small talk as a part of the telemedicine encounter, such as allowing them to describe the reasons for the consultation or to express their concerns.

Set It Up Right

Both the patient and provider can make small adjustments to their environment to maximize the chances of a successful telemedicine session. For example, ensure there is adequate and natural lighting where possible, have a neutral and darker background and making sure all of one’s head and upper torso are in full view of the camera. The use of a headset containing a microphone has advantages such as cutting down background noise with an improved ability to hear more clearly. Headsets can minimize echo and can give patients an increased sense of privacy.

Consider the location of the video camera. Having it just above the screen of a laptop or desktop is optimal. Use of ‘picture-in-picture’ display allows the presenter to view how they’re being presented to the patient in real time. A word of warning however – clinicians should not be tempted to watch themselves in the little window while talking. Looking into the camera helps to give the patient the impression that the provider is maintaining eye contact during the session.

Distance Isn’t Always Bad

The issue of depersonalization is frequently cited as a potential telemedicine drawback. However, the distance created by using telemedicine can be a source of clinical benefit in mental health. Patients can use telemedicine to avoid the potential stigma of having to visit a mental health facility in order to access services. Along similar lines, the distance and remoteness generated by telemedicine can create a sense of safety and depersonalization when discussing sensitive or stigmatized topics. Telemedicine puts control in the patient’s hands, even allowing patients the option of turning off the camera to speak with a degree of privacy.

Mental health has been a champion adopter of telemedicine. The available research and everyday experiences of those using telemedicine in delivering mental health care can offer insights and tips for other disciplines that perhaps haven’t fully realized the potential of this technology. Much of the advice is straight forward and easily implemented but it can have a tremendous impact on the telemedicine experience for both the provider and the patient.

org psych

How I Drove Change From the Back Seat Of A Large Organization

This post first appeared on Medium.

I recently applied for a job that asked me to write a 500 word essay on what an organization of my choice can learn about change and how they should do it. The essay I wrote in response ended up being a (true and) decent story that I’ve decided to share more widely.

The impact this course and this professor had on my business school experience is a larger one that I give credit for. After taking this course I switched direction entirely within my business degree to focus my energies on everything I could relating to strategy and change management. In the jobs I’ve had since graduating, I’ve never really had the opportunity to work solely within a strategic or change management role. In the spirit of change, let’s see if this essay can help with that.

One of the courses I had to take at business school was called ‘Organizational Psychology’. I had taken numerous variations of psychology subjects as an undergraduate (think abnormal, social, developmental, neurological) but I had no idea that ‘OP’ existed as a standalone discipline. I was fascinated by it and particularly by the research being done by my professor.

My professor was researching people exactly like me – allied health professionals and the impact their work had on their perception of a range of areas including job demands, job control, support, satisfaction, commitment and psychological distress.

At the time I took this subject I worked for a large public health service in Australia – a large organization with over 14,000 employees and millions of episodes of care occurring inside large hospitals every year.

In this role I had the amazing opportunity to help people with communication and swallowing disorders, every single day. But after 10 years the job wasn’t making me happy anymore. Lots of what my professor was researching I had experienced myself – isolation, emotional depletion and compassion fatigue. It was like this professor was holding up a mirror to how I felt about my job and couching it within a proper research framework.

My professor’s research included suggestions for healthcare organizations on how to improve the wellbeing of workers like myself. Sensing I had an opportunity here to shine the torch on my own unhappy working existence and potentially help others in a similar situation, I wondered how a single person like myself could bring about any real change or cultural impact. I talked to my professor about my options.

He suggested coming to the hospital to give a guest lecture to get the issues out in the open. I was hesitant because I knew much of what he was going to say wasn’t what upper management wanted to hear. There was a tendency to deny and discredit burnout like a pile of discarded hospital scrubs. But we went ahead and did it anyway. My professor came to the hospital and gave a hard-hitting presentation about all the reasons why my working life sucked, and the research evidence behind it.

During the presentation I sat next to my boss’ boss – one of the most powerful people in the organization. I was nervous she’d interject, stand up and argue, or worse, get up and leave. Instead I watched her furiously scribbling down notes from the slides that described what organizations could do to better support people like myself.

In the months that followed my professor reached out for an update on the organization’s progress. I was happy to report that one of his key suggestions (implementing peer supervision sessions for allied health professionals) was in the early stages of pilot implementation.

This entire exercise taught me that it is possible for one person to bring about organizational change, even in a small way. It helps to collaborate, have an authoritative figure in your corner, solid data evidence and the courage to do so.


Why Are There No Women Influencers In EDM?

This post first appeared on Medium.

This week the music blog Your EDM released their list of 30 Under 30 in EDM. I certainly noticed — only two women made it onto the list (the two sisters, Jahan and Yasmine Yousaf, aka Krewella), and even then they occupied the same single spot.

I don’t want to debate who made the list and who didn’t but what annoyed me about Your EDM’s write up was the author’s obliviousness and lack of acknowledgement that very few women made the cut.

Others have also noted what Your EDM failed to point out. A friend of mine pinged me last night and asked me to offer up some names for 30 women under 30 in dance music. I was stumped. The best I could come up with was a handful of notable female artists (like Nervo or Maya Jane Coles). Even when I expanded my range to any women of any age influencing dance music, my list was still surprisingly thin.

Diving deeper into Your EDM’s 30 Under 30 list, you’ll notice there’s a healthy mix of names that are primarily known as being artists (like Skrillex) as well as those that aren’t known for making music themselves but do a heck of a job as young promoters, label heads and managers (like Jake Udell).

Why are women so under-represented in lists like this and especially as young industry leaders and influencers? How do we get more women onto future lists? Here are some thoughts.

1) Electronic music is made mostly by men.

You only have to look at lists like RA’s Top 100 DJ’s or even Triple J’s Hottest 100 to see that men outnumber women when it comes to making EDM and electronic music at its highest levels.

It’s possible that when the people producing the final product are mostly men, you run the risk of making the industry less attractive to women. This isn’t as far-fetched as it sounds and this same scenario plays out in other industries as well. Perhaps there is common ground between why few women get into electronic music and why women are under-represented in other industries, like tech.

Thinking about it in another way, are there plenty of female artists around, but they just don’t do as well at the elite level? And after Patricia Arquette’s Oscar speech last weekend, I can draw this long bow too — is there a wage imbalance at play? Are women paid less than men at the higher music industry levels? It happens in the movies, so why can’t it happen in music too?

2) EDM is mostly marketed to and consumed by men.

I should preface this by noting that I am not your typical electronic music fan. For starters, I’m a girl. I’m also over 35. I turn up at electronic music events and I feel like the resident grandma. It doesn’t stop me. I have so much enthusiasm and passion for engaging with, consuming and writing about good electronic music.

I have noticed a pattern in the events that I attend — the more underground and less mainstream the event or act, the less likely women are to attend. It can mean that I’ll show up in Brooklyn somewhere and be seriously outnumbered in the ratio of men to women.

Consuming EDM at festivals or shows usually comes in an environment that’s gritty, loud, very dirty and full of small packs of men. For some women that kind of environment could be mildly annoying at best or viewed as dangerous at worst. I’ve experienced the powerful collective energy the large crowds at these events can generate and while it’s a rush, even I’m intimated sometimes. I can see why women avoid these environments — the fear of being crushed, trampled and injured by the surge of forceful energy in front of a stage is a real one. Women often consume EDM at its sidelines.

It’s a perpetual cycle. If males are more likely to attend and engage with electronic music, then the promotion, marketing and product offering naturally gets aimed at the largest and strongest market. Women get cut out of product-promotion loop.

3) Women, especially younger women, are reluctant to step up and out from traditionally safer industry roles like marketing, promotion or PR.

I have no actual proof of this but I see it happening in other industries like tech. Women, especially younger women, are often drawn to industry roles that rely on soft skills and relationship building, like PR or marketing. When women are younger, they often lack the confidence, the role models, the guts or the support to take on more senior or outlandish roles that might thrust them more into the spotlight. Taking on these senior roles is the catalyst for building influence inside an industry and is what helps propel people onto 30 under 30 lists.

So what’s the answer? How to we get more women onto next year’s 30 under 30 in EDM list? Completely rethinking how EDM is promoted to women to encourage more of them to attend events would likely help. Promoting long-term loyalty and converting young fans into lifelong ones isn’t done well. Most of all the industry needs to better collectively nurture, encourage, mentor and fully get behind the young female talent it already has and what’s waiting in the wings. This applies at an artist level and even more so for women working to influence and build a music career behind the scenes.

nyc skyline

The Same But Different – Comparing America and Australia

One of the fascinating things about living in another country is getting your head around the social and cultural differences at play. Those ‘at play’ differences are everywhere and if you’re mindful, you can find and explore what’s both different and familiar at the same time.

You might imagine that between Australia and America there aren’t a whole lot of differences. But they’re there. When I get asked, the simplest way I can describe it is to say that Australia and America are the same but different.

Little things sure – the accent, the lingo, the endless cricket vs baseball comparisons. Americans and Australians speak the same language, watch the same movies and share a mutual respect and fascination for each other. And increasingly there’s a bridging of the two countries that manifests in small ways, like when flat whites get introduced on the menu at Starbucks.

All that isn’t enough for me. I wanted a wider framework with which to think about how America and Australia are the same but different. In searching for one, I read this book called Fairness and Freedom:  A History of Two Open Societies: New Zealand and the United States. It’s written by an American, the Pulitzer Prize winning author and historian David Hackett Fischer.

freedom fairness

My homeland might not be New Zealand, but there is much that can be extrapolated from this book about its very close regional and colonial cousin. As such, Australia is mentioned frequently throughout this book.

The basic premise of the book, as evidenced from its title, is that Americans value liberty and freedom, while in contrast, New Zealanders (and by extension Australians) value fairness and equity.

Sounds right. But why? Turns out the answer to that question goes back hundreds of years. According to Fischer, the answer lies in our common British colonial past.

The Brits settled on the east coast of America roughly in the early 17th century. But it wasn’t until the mid 19th century that they got around to colonizing and settling in New Zealand. It is that 200-year difference between the British settling of America and New Zealand that is so crucial.

Fischer describes how the British colonists who settled in America in the early 1600s did so with under the auspices of control, tyranny and an absolutism that went on for generations. Two hundred years later when the British settled New Zealand (and Australia) they did so with different principles and with a much more softened spirit.

The American ideals of freedom and liberty can be traced back to the long battle the earliest Americans had with their British colonizers. More specifically, it was a 6-generation struggle between the yet-to-be-independent Americans against tyrants sent over from England to bring them back into line with their British rulers. The American War of Independence, and subsequent Declaration of Independence celebrated on July 4th, put an end to this tyranny. Fischer explains:

“These many imperial conflicts are little remembered in the United States, but together they had a major impact on its history.. The American obsession with liberty and freedom was in large part a product of that long experience.. That habit of mind found a permanent place in American ways of thinking about the world”.

This is all in contrast to Australia and New Zealand who won their freedom from the mother country without having to fight against their British founders. The path to nationhood for Australia and New Zealand was a gradual one, with no war, declaration, constitution or significant struggle against the British. Freedom and liberty therefore were not strong themes from this time or in subsequent generations. Instead Australia and New Zealand are much more wrapped up in ideals of fairness, equity and social justice.

Case in point, Australians believe that everyone should help themselves, but if you are genuinely in need then the government should be there to provide assistance to you. This explains why Australians are for the most part happy to pay higher taxes to fund services for people with genuine needs, such as hospitals for the sick, services for the disabled and care for the elderly.

To many Americans, this concept is foreign because the prevailing thinking is one of every man for himself. It is accepted in American society that one person can do well without depriving another. Americans pride their constitutional right to freedom of speech while Australians struggle to understand how to integrate it with their preexisting ideals of mateship and fairness.

The book concludes with what is perhaps its most difficult question – is it possible for a nation to be both fair and free? Can freedom, fairness, liberty and natural justice ever sit together? Not an easy question to answer and I’m certainly not going to tackle it. Fischer offers this advice:

“In 1940, that was a problem for the future. In the twenty-first century, it is a question for our time”.

What this book gave me, besides a fascinating history lesson, is a look at the cultural, historical and societal differences between America and New Zealand, and by extension, Australia as well. It provides a summary of the historical literature on a wide variety of subject areas including military and wartime traditions, racial and indigenous issues, government, women’s rights, religion, immigration, even how the different countries have responded historically to various financial crises.

While this discussion is interesting, what does it all mean for expats like me who spend significant amounts of time immersed in American culture and society? How does it help me with the ‘at play’ differences that are fascinating and overwhelming at times?

I owe it to my adopted country to have an awareness and appreciation of what dominates American culture and thinking, and why. It’s what smart expats do. That deeper understanding allows my Australian upbringing to fully immerse and adapt in new and exciting ways – to all that’s the same but different.



On Being A Blonde in New York City

The other night I was minding my own business walking somewhere along Sixth Avenue and trying to find the entrance to the subway.

A young-ish man came up behind me and said, “Excuse me, are you a movie star? Cause you look like one.”


“Umm.. no. What? Why?” I fumbled.

He asked me what I was doing in New York, did I speak French because he did and whether I could get cabs easily because I was blonde.

I flubbed my way through some lame responses to have him launch into a sidewalk lecture about how blonde women have it so much easier in this world. According to him, blondes are more beautiful thanks to their eyes often being blue and because they have symmetrical faces.

“This guy is so full of it,” I thought to myself. “Blonde doesn’t always mean beautiful. What do you even know?”

I started to think about how I was a blonde little girl that morphed into an ugly teenager practically overnight. That when I was younger I got picked on and teased incessantly. I had braces, terrible pimples and a giant Wicked Witch of the West nose. I was gangly and shy and sucked at being social.

When you spend your teenage years awkward and unattractive, there’s a part of you that always believes it, no matter what happens to your appearance later in life. I am stuck with the mindset that I grew up with – the world doesn’t owe me anything because of how I look. Since I was a teenager I’ve had to work hard to attract anyone, be it friends or romantic partners. That has always forced me to pour more of my efforts into developing my brain, interests and personality, rather than relying on and having others fawn over my looks. Why then would I even care what my hair color is?

I said none of this, of course, to the guy standing in front of me giving me his blonde = beautiful mantra. When he finally finished he closed with, “Here’s my card and oh, by the way, my office is on 15th. Do want to get coffee sometime?”

I was waiting for that last line. New York men are such opportunists. He shoved his card into my hand and walked off.

I stood in the street, somewhat perplexed. Did that guy really just think I was a movie star? I looked down at his card. It said Dr. Michael Parker Benjamin – Psychotherapist** in black sans serif type. Did that guy just think I’m nuts because he could read my mind just now?

I told a couple of my New York friends, both male and female about what happened and why.

One friend told me I’m the blondest woman he knows in the city. Another friend told me to wake up to myself and know that blondes get more attention in this city. People assume you’re foreign. Because most New Yorkers are descendent in the most part from immigrants with southern European or Jewish backgrounds, that is, people not generally known for having blonde hair.

That explains why, in this city at least, I am often referred to as ‘the blonde’. Because I’m usually the only one. I’m the blonde in the ballet class. I’m the blonde at the office. I’m the blonde on the subway. I’m the blonde in the line at Chipotle.

The same kind of blonde reference doesn’t work in my native Australia because lots of people have blonde hair where I come from. It also explains why in this city I often get asked if I’m from Sweden. Or Germany. It’s not until I start talking and people hear my accent – that’s usually enough to kill the ‘you must be from Scandinavia or whatever’ references.

And so, if being blonde in New York City isn’t all that common, and considered by random men on the street as a rouse for hitting on strangers, what does it all mean?

If you believe this New York Times article, a ‘New York Blonde’ (note the capitalization) should have these adjectives attached to her; ‘dazzling’, ‘rare’, ‘gold’, ‘status’. She also does this..

“The New York Blonde embodies a lot of the values of our materialistic society.. she is thinner, blonder, richer than the rest of us, and she has better shoes. Hair that gorgeous is hard to attain. She creates in the viewer a sense of lack, a message that says, ‘I have more than you.’ This is power.”

I rolled my eyes when I first read this. This kind of instantaneous judging and pervasive shallowness is chronic in this city and it’s probably what I dislike the most about the social culture in New York.

But I recognize now that if blondes were more abundant in New York, their perceived worth would likely diminish. The reality is that even in a city as big as this one and so choked with beautiful people, rarity adds value. Therefore the kind of superficial nonsense outlined in the Times article above is probably more accurate than I want to give it credit for.

Does having blonde hair in this city help me get dates? Probably. Does it help me when I walk into a business meeting full of men who work in tech? I don’t even want to know. It is just the color of my hair. Even in the socially stunted and superficial playground that is New York City, I refuse to let something shallow like the color of my hair define me. Instead we’d all be better off sticking to what I’ve had to do since I was an awkward teenager – to focus inward to find real meaning and work on what’s there instead.


** Not his real name!


The Lobster Roll Guy

I knew it was over as soon as he said, ‘How old are you again? Oh wait, and when is your birthday?’

It’s another late night dinner, another night out, another in a long and steady catalogue of dates with Jonathan.

I’m munching on green beans and mash. Shaking my head slightly, I think to myself, ‘Oh no. He doesn’t even know how old I am’. I can feel myself start to sink low into my chair. My chest starts to feel empty and heavy at the same time.

He didn’t remember, but he helped me celebrate my last birthday a few months earlier. He didn’t know, but I knew his age like it was etched into the back of my hand. He probably wouldn’t remember this detail either; the romantic bar that was set months earlier by our chance meeting with a stranger that I later called The Lobster Roll Guy.

Jonathan and I met The Lobster Roll Guy in one of those random and fleeting New York-style meetings.

Night’s end and descending inside an elevator, Jonathan and I were leaving a charity event together. We shared an elevator with another man who oddly announces that he has just eaten the best lobster roll of his life.

‘What’s a lobster roll?’ I asked him. I meant it. I’d never seen or eaten one before.

The stranger’s drunken eyes unglaze for a moment. He looks at me, ignores my question and says, ‘Wait, keep talking.’

I must have looked confused because Jonathan chimed in and said, ‘Your accent. He wants to hear more of your accent.’

‘Oh, right,’ I replied. Not an uncommon request. ‘I’m Australian,’ I smiled.

The stranger nods at me, cocks his head to one side and looks up at Jonathan. His eyes dart between the two of us. He’s summing up the situation in the remaining seconds as the elevator hurtles towards the lobby. The doors open and as he steps out of the elevator, he leaves Jonathan and I with this parting comment.

‘You, sir, are the luckiest guy in the world.’

Jonathan laughed. I did too. Truth be known, I beamed. Not because I think it’s true but because I really wanted Jonathan to believe it was true. Regardless, nothing feels more corroborating than external validation, even when it comes from drunken strangers who have a thing for lobster rolls.

I later renamed the stranger inside the elevator as The Lobster Roll Guy. I thought a lot about his comment and in time it’s become somewhat of a dating yardstick. The Lobster Roll Guy made me realize how important it is in early dating that both sides feel like the luckiest person on Earth. It has to be mutual in order for dating to feel fluid and reciprocal.

Only with Jonathan, it didn’t. If I’m honest, it never did. Over green beans and mash and him telling me that he had no idea when I was born, I could no longer ignore what I’d been denying for a long time – that I wanted us more than he ever would.

There were shared interests, but never a shared spark. A mutual caring that grew, but never developed. I hung with him and his guy friends, only I was a girl. I was frequently his mate, but only ever his friend. He always kept me at arm’s length, and I naively filed that under the complexities of New York City dating.

It went on like this for a long time. The convenience worked for us both but I kick myself now for letting it go on for as long as it did. A part of me wonders if he, consciously or otherwise, fed me these steady negative signs in order to make a dignified exit.

After getting through the last of my green beans, I could no longer deny that the end was now here. When we finally talked it out later that night, I refused to sob about it and we agreed to remain friends.

He was in my life for all of two minutes and only told me three sentences but The Lobster Roll Guy taught me a lot. Mostly that the sweet spot in dating comes when both sides feel they are the luckiest person on Earth to be dating the other.

Now that the dust has settled on Jonathan and I have the wise lessons of The Lobster Roll Guy deep in my back pocket, there’s really only one thing left to do. If I am going to find the one who thinks of me like The Lobster Roll Guy, I probably need to try a lobster roll for myself. And that then begs the question.

Where is the best place in New York City to find the best lobster roll?

I’m still searching.

Stretcher in Hospital

When Clinicians Go Corporate

Professionals who make the jump from hospital bedside to the corporate world bring a unique set of skills and experiences to the business table.

I’m one of them. I worked as a speech-language pathologist in large acute hospitals in Australia for almost 10 years. I treated patients with strokes, other neurological pathology and head and neck cancer. I transitioned out of the clinical world via an MBA several years ago and I now work for a health technology company.

Nearly 15 years after first graduating, most of my peers are now in some kind of middle management role. I know only one or two like me who made the full corporate/business jump. People like me see their influence and expertise being directed beyond the four walls of a hospital. We upskill and re-educate, shift and pivot, usually into different careers and industries while taking a unique set of skills and experiences with us.

What are are those unique skills and experiences for clinicians who go corporate, and what are their advantages? Here are some thoughts.

1. A deep appreciation and understanding of the experience of illness.

Those with clinical experience already have a deep fascination and interest in health, disease and healthcare.

Taking that a step further, when you work with patients in hospitals you develop an intimate understanding of the patient journey. Your job is to help people to navigate the experience of illness and disease. You learn to recognize the patterns of how patients, money and influence flow through the healthcare system. You deal with the unique politics and organizational structure that’s present in hospitals and other large healthcare organisations.

2. Instant commonality and connection with healthcare professionals.

When I engage with clinicians today as part of my current job and explain that I was once like them, there is a shared sense of having ‘worked the trenches’. It feels like an instant commonality, a mutual respect and a sense of camaraderie.

I felt it too when the tables were reversed. When I was a clinician, rightly or wrongly, I always respected professionals who came from where I did. And I could always tell when another professional had a clinical background – in their language, knowledge and approach.

3. Understand and can deal with risk.

Clinical work is much grey-er than most people realize.

More often than not, the course of action to take with a patient is not clear. It’s a process of gathering as much good information as you can, consulting with everyone around you, drawing on your prior clinical experience, knowing as much of the research evidence as you can, and then problem solving it out to the best of your clinical ability.

When I worked as a clinician, I dealt with disease risk every single day. My area of expertise was dysphagia or disordered swallowing. I was dealing with something that in normal people is a complex and intricate process involving coordination and timing of neurology and musculature.

Until it goes wrong. The ability to eat and drink easily and safely is something that most people never pay attention to until it doesn’t work properly. Swallowing just happens and there’s no true way to tell exactly what’s happening inside someone’s throat. You can’t ‘see’ inside someone’s neck to find out exactly what was happening while they eat or drink. I had to infer lots of things and manage each patient’s relative risk of having food or drink end up in their lungs rather than their stomach.

4. Expect long hours and hard work.

Everyone works hard inside a hospital. The hours are long and intense, you are constantly on the move and you hustle.

Information comes at you from everywhere. Your job is often to drill down to the info that is of most value to you and your patient. In a hospital there is a continuous and consistent push towards the same common end goal – get the patient well enough to discharge them. In the business world by comparison, I find that sometimes the end goal can be less clear or worse, not clear at all.

5. Are team players, highly empathetic and good with people.

Most clinicians are good with people and are highly empathetic. What drives them towards clinical work in the first place is their tendency to be givers who are service-orientated, humble and smart. They generally come from a place of compassion, hope, comfort and an intense desire to want to help others.

Clinicians have to talk to, connect with and build rapport with different kinds of people. The best clinicians do it naturally and authentically. That ability to connect and talk with anyone lends itself well in the business world, and especially in tech where there’s a tendency for insular work among smart tech minds.

I cut my professional teeth within a team environment that knew the value of collaboration. In my clinical experience, I worked in small teams alongside other healthcare professionals and together we treated patients to the best of our collaborative ability. The best teams I worked on had a common goal, competent members, a strong leader (usually the resident doctor) and valued the input of each of its members.

6. Expect pressure and can handle it.

There is no other pressure quite like dealing with sick people. Make a wrong move in business, and someone might lose money. Have a brain fade inside a hospital, and you could make a person sicker, or worse.

The pressure can be intense. I frequently dealt with very unwell patients with special kinds of breathing tubes (specifically, tracheostomy or tracheotomy tubes). On more than one occasion I had mere seconds to decide whether I could do something to make a patient breathe more easily or call in reinforcements in the form of the crash cart.

There’s no other working environment like a large acute hospital. It wasn’t until I left the hospital as a workplace that I realized what a unique and unusual workplace it actually is. For many years I didn’t know any other workplace.

No one really talks about what it’s like to work inside a hospital. You are in the front seat, witnessing modern western medicine in full flight. From that front seat you can see humans at their worst. Sickness and illness become the norm, to the point where you forget what normal ageing and healthy socioeconomics actually look like. A routine day for you is never a routine day for your patient and their loved ones.

To summarize, professionals like myself who were once clinicians and go on to roles in the business side of healthcare bring a unique skill set and experience to the business table. We appreciate and understand the healthcare system better than most because we were once intricately a part of it.



23andme and Angelina Jolie

More from the archives of my old blog. I wrote this piece back in June 2013 after I spat into a cup and sent my DNA off for a full ancestral and health analysis.

My spit revealed a lot. Turns out I am of 99% northern European ancestry (no surprises there). But most shockingly, I have a genetic variant that’s associated with a higher risk of developing Alzheimer’s Disease. 

Skillfully I was able to weave my own experience of genetic testing with that of Angelina Jolie’s and her public battle with breast cancer. My experience with personal genetic testing then begs the question – would you want to know what’s lurking in the DNA of your spit?

A good friend and I were discussing Angelina Jolie’s recent revelation that she underwent a preventative double mastectomy after learning she carries a genetic flaw that puts her at high risk of developing breast cancer.

Through this discussion I learnt about 23andme; a personal genetic testing company co-founded by Anne Wojcicki, the wife of Sergey Brin. He’s also a co-founder, of Google.

Here’s how 23andme works.

Pay $99 and order the kit online. They send you a container. You spit into the container. You spit into the container for what seems like 10 minutes. You send it off (but don’t post it in the state of New York, for some dumb reason it’s illegal if you do). Four to six weeks later and they email you the results.

Super cool, I thought. I’m curious about everything, especially myself. I cannot resist this.

And so welcome.. to the fascinating world that is personal genomics and crowd science.

My results

The results are divided into two separate sections, health and ancestry. I’m going to bypass the ancestry stuff and discuss some of the interesting findings from the health section of my report.

What came as a surprise was my risk of developing Alzheimer’s disease. Based on my being female and of solely European ancestry, the testing revealed that I have double the average risk of developing Alzheimer’s disease between the ages of 50 and 79.

This is because I have one copy of the genetic variant that is associated with a two-fold increase risk of developing the disease. Luckily I don’t have two copies of this same variant, or my risk would shoot up to an 11-fold risk. Yikes.

What does this have to do with Angelina?

Angelina revealed that she carries an inherited genetic mutation known as BRCA1. Along with BRCA2, these two genetic mutations account for most cases of inheritable breast cancer in women. Prior to her recent surgery and treatment, Angelina’s doctors estimated her risk of developing breast cancer was an alarmingly high 87%.

It’s important to note that falling into such an extremely high-risk category is rare. Angelina has the double whammy of carrying the genetic flaw and having a strong family history of the disease.

Writing in the New York Times, Angelina reveals that by undergoing the surgery, her risk of developing breast cancer went from 87% to under 5%. Given the drastic drop in risk from undergoing the surgery, little wonder she did what she did.

I am in no way trying to compare the gravity, seriousness and impact of Angelina’s genetic testing experiences with that of my own. But by looking at what we know about Angelina’s experience with genetic testing with my own, some important issues surrounding genetic testing and personal genomics can be extrapolated.

It’s all about risk

Fortunately for me, I don’t carry an inherited genetic mutation like Angelina. Instead what I have is a single copy of a variant of a gene that increases the risk of developing Alzheimer’s Disease.

According to the report from 23andme, my risk of developing Alzheimer’s Disease between the aged of 50 and 79 based on genetics alone is estimated at 14%. Without the gene variant that I carry, my risk would half that at 7%.

While not dramatically high, a 14% risk of early onset Alzheimer’s disease is still double the normal average. I have built my career around neurology and have seen enough Alzheimer’s disease in my time to know what the end stages of the disease are like. Alzheimer’s disease and other dementias are awful, insidious, non-curable and relentlessly progressive diseases.

Angelina no doubt had top specialist doctors to advise her. These doctors would have taken into account the results of her genetic testing, family history and a whole range of other data to arrive at her individual relative risk for developing the breast cancer. In my case there are no doctors or specialists examining all the other factors that might contribute to my risk of Alzheimer’s Disease, or any disease for that matter.

Because 23andme offers informational testing only. It is not diagnostic testing and it does not have the benefit of having specialist doctors to assess your individualized risk based on other important factors besides your genes (like family history, other medical history and environment).

To its credit, 23andme tries hard to break down and visualise the science for the average person to make it palatable and digestible. But ultimately comparing numbers with numbers is simplistic while trying to decipher to complex science behind disease risk is not.

Now what?

Revealing a genetic variant of a terrible disease for which there is no cure has the potential to seriously alarm and upset people. Armed with this new information, what do people like me do about it? What should I be demanding now from the medical profession in terms of future disease prevention, monitoring or management, if anything at all?

But 23andme doesn’t properly acknowledge that the information it can reveal can be misinterpreted by its customers who don’t understand the concept of risk, the distinction between informational and diagnostic genetic testing and the importance of having disease risk assessed by specialists within the context of other factors such as family history and environment.

A classic case of TMI?

I don’t think of it like that. Not at all. In no way do I regret undertaking this kind of testing.

I am buoyed by the fact that there’s no known history of Alzheimer’s Disease in my family, early onset or otherwise. Both my grandmas are textbook examples of how to age well. They are treasures. Both are in their mid-80s and they continue to be fit, thriving and engaged members of their communities. My Gran is all over facebook while my Nan is the most resilient person I know.

In any case, I love this kind of stuff. It combines areas I’m fascinated with; disease, risk, statistics.

For the lucky majority of us, our genes are not our destiny. Risk is just risk. Risk is not an absolute. After all, many men and women with the BRCA1 gene mutation never develop breast cancer. Many people with the same genetic variant that I have never develop Alzheimer’s Disease either.

Informational genetic testing has added to my health knowledge. But what’s more powerful is knowing that one’s best chance of preventing disease, genetic or otherwise, is to prevent it in the first place – eat a sensible balanced diet, maintain a healthy weight, exercise moderately and limit alcohol, cigarettes and stress.

Me and my genes are going to do just that.



Ready? Aim! Fired.

I got fired once.

As hard as it was at the time, it became a tremendous catalyst for change that eventually turned out to be the best thing that ever happened to me. Simply put, if I hadn’t got fired on this day, I would never have ended up in New York City.

This happened back in March of 2012 at the closing stages of a very hot and memorable summer where I spent every evening after work watching the sun set over one of Adelaide’s numerous and incredible city beaches. 

photo 1

Sunset over Glenelg Beach in Adelaide, Australia

I wrote this post about a week after I got fired and I’m glad I did. It brings back very powerful memories from that day and it now serves as a reminder of how traumatic the event was, and how god-awful-hard the months were that immediately followed.

What I like about this post is that I had no idea what was coming next. At the time that scared me greatly. I get the sense from the final paragraphs that maybe I knew this was big but I could never have predicted how big or what a life-changing event getting fired that day would turn out to be.

Why share this with my now considerable audience? Why openly admit professional failure?

I’ve been inspired by two things – this recent HBR blog post on openly talking about failure and I’ve been reflecting on my own career change journey thanks to my involvement in co-hosting this upcoming event in New York. 

I often think about what I’d be doing now if I hadn’t got fired that day. Would I have continued my cosy set-up in Adelaide working as a management consultant? Or would my feet have eventually got itchy, and I would have spread my considerable independent wings regardless? Read on and judge for yourself.

I lost my job last week. And no, I am not joking.

Technically I wasn’t fired. My job was declared redundant. Like the difference between the two is supposed to make me feel better. It’s a horrible word, redundant. And to be declared redundant? Officially it means deprived of one’s job because it was no longer necessary for efficient operation. For efficient operation? Fuck that. I’m still sitting here, the first Monday morning in over 10 years and I have no job to get up and go to. It feels very strange.

This was supposed to be my dream job. My dream post-MBA job. Recall that just four months ago I chucked in the very secure long term job I had in public health, packed up my life, moved on my own and to a different state for this job.

This is very unfamiliar territory for me. I have never been fired or made redundant from anything. I have never felt so comprehensively rejected in all my life, and foolish, and completely demoralised. Welcome to the real world of work, Sarah! You are no longer the sheltered pseudo public servant you once were, in a cushy job where no one gets fired.

I am not going to go into the specifics of why I lost my job and I don’t want to bash my old firm. I need to tread lightly here. What I will say is that the GFC is not over, kids. This country has not escaped it. It is starting to permeate into government departments who are reducing their spending accordingly.

I knew for the better part of two weeks that this was coming. While no names were mentioned initially, as soon as I heard the boss say ‘reducing headcount’, I immediately felt very vulnerable. I was the last person they hired. I may have had nearly two weeks to sit with it but how do you prepare yourself knowing you’re probably going to get fired?

I had wondered exactly how they would do it; the part where they tell me they are terminating my employment. Would they take me to a public place, tell me I have to leave, where I couldn’t make a scene or hissy fit it out in public? Or make a meeting time with me on Outlook, where I would know in advance what was coming? I knew my head was on the chopping block. Decision day arrived. It was uncharacteristically grey and rainy outside and it mirrored my mood. I wore my favourite pretty red hair clip and hoped for a shift execution.

I am proud of me for handling it as well as I possibly could. I listened to what sounded like a short rehearsed speech from my very nervous boss. I had time to cry about it. I was told to gather my things. I had $30 cash stuffed into my left hand. I was promptly marched out the door and into a waiting taxi. The fucking indignity of it all. How’s that for a swift execution? It was all over in 15 minutes and by 9:30 that morning, I found myself back at my apartment wondering what the fuck just happened.

Two weeks is a long time to wait to learn your fate. It was incredibly difficult to front up to work, knowing I was probably going to get fired soon, and actually concentrate and do anything that resembled work. It was like a rollercoaster. At times I brushed it off and felt fine about it, other times I was convinced I would keep my job and other times I drove myself crazy and over-thought it to the point of floods of tears. Only natural I guess.

I hate thinking I was an easy target for firing because of my personal circumstances. Or lack of them. I don’t have a family or partner to take into account. I don’t have a young family or kids in private school. I’m the one with the newly minted MBA who can take it pretty much anywhere and if that fails, can always use my clinical background to fall back on. I could always do a PhD if I got really desperate. I may have options, I have more options than those around me but I have worked hard to set myself up to have those options. Nonetheless having options doesn’t make it any easier when you’re the one in the firing line.

I have hated telling people about what happened. Especially my old colleagues in public health, where redundancy isn’t part of their vocab. Some people I just haven’t told. I am completely ashamed to put ‘unemployed’ and ‘my name’ into the same sentence.

It’s been nearly a week since it happened and I’m feeling a little lost. As much as I’ve resented it, my work has always been a huge part of my identity. Now that’s gone and I’m not sure what I am anymore. I am not used to having so much time on my hands.

But I am much more than my work. More than a growing collective body of research. I get the feeling that this experience is going to prove it to me. I can take the time to cherry pick and wait for the best job with the best fit. I can explore what I am truely passionate about, what blows my hair back and what will really make me jump out of bed each morning.

In the meantime I have to stay positive and busy. I can finish off a research paper that’s up for presentation mid year. Think of all the running I can do! I have no excuse for not smashing up that half marathon I’ve been eyeing off next month. I’m going to watch every single movie nominated for Best Picture, all in one hit. And the tv I can watch! American tv is cranking up soon in the lead up to its summer hiatus. Awesome. And what about all the wonderful new music waiting for me to explore and wrap my ears around? I can catch up with pals and not be the one that has to rush back to work or be home before 10 on a weeknight. My kindle is going to get a serious work out. I can read and read and read and read. I can even try meditation. I can take dance class every single night of the week. I might just do that.

I will be okay. I am not going to panic. I need to spend time thinking hard about what happened and what I want to do next. I need to keep the bigger picture in mind here, now more than ever. People get fired every day. I can keep a roof over my head and food on my plate for a very long time to come. And I don’t have to quickly scoff my lunch sitting at my desk at 4pm any time soon.

On the back of every bus ticket sold is this town they print short motivating affirmations. On the back of my bus ticket last week was this very timely quote.. every ending is a new beginning. Exactly right. As for my new beginning? Dusting myself off, taking full advantage of the downtime and not letting this smash my confidence are some of the options I’m considering.



The Bright Red Sharpie of Life

I have been trawling through my archives for more standout posts and came up with this one.

I wrote this about 18 months ago – back in February 2013. I recall typing this one out on my iPhone while on a bus commuting either to or from an airport. I can’t recall exactly where I was. I want to say I was in Australia but I can’t say for sure. That (Australian) summer was an especially heavy travel time for me as a flitted between northern Australia and South East Asia doing, well, whatever I wanted.

That kind of freedom and opportunity gave me incredible clarity. In this piece I used a simple Sharpie metaphor to describe how my early adult life was dominated by meeting societal expectations, the pressure I felt to conform and the struggle I went through to eventually leave all that behind.


As one navigates early adulthood and forges a path for themselves, you take the lead from the bright red sharpie of life.

There are boxes to be sequentially ticked off. You use the bright red sharpie to slowly tick off these boxes.

You don’t know it. But those boxes tick off items on an invisible but powerful list of social norms and conformity.

House, home, husband.

Tick, tick, tick.

Profession, career, travel.

More ticks.

The ticks don’t lie. The ticks should make you happy.

But deep down you know that you aren’t.

And so the bright red sharpie of life turns on you.

Instead of ticking off the remaining boxes like you expect it to, the sharpie keeps its cap on and starts tapping at you instead.

It taps at you from the very corner of your mind.

Tap, tap, tap.

The taps gradually get louder until they crescendo into a persistent scream telling you that it’s all so wrong.


It builds to a point of fog and frustration and you can’t ignore it another minute.

Something has to change to make the tapping go away.

To make it stop, you make changes. Big, profound life changing changes.

You tell yourself change is good. But change is also hard. Insanely hard.

Now it doesn’t tick or tap. The bright red sharpie of life just draws. It’s a giant jumbled red mess. Like how a 3-year-old might draw a snowstorm. Or a thundercloud.

You wonder why.

Did you upset the bright red sharpie of life? Or were the tick boxes simply wrong to begin with?

With insight, bravery and the benefit of the healing passage of time, the sharpie begins to draw you a different path.

One without tick boxes or conformity.

You throw away the tick boxes altogether and call them out for what they are – an illusion and a myth.

Then the bright red sharpie of life stops altogether. No ticks. No taps. No chaotic red drawings of messy red thunderclouds.

With enough courage, you do away with the sharpie. It gets replaced instead with a plain white canvas to call your very own.

And what you’re left with is an understanding – that using the bright red sharpie of life to tick off boxes is right for some people.

But not for you.



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