In this podcast we explore the past, current and future ideals of ‘What makes a good boss’ in medicine gathering points of view from Eloise Sobels, a medical student, Amy Coopes, a junior doctor and Rhea Liang, a General and Breast Surgeon.

Script Writer:  Eloise Sobels

Editor:  Evangelie Polyzos

Interviewees:    Amy Coopes, Eloise Sobels, Rhea Liang

Interviewer:  Amy Coopes

About Dr Amy Coopes

Amy Coopes is a junior doctor and journalist who swapped news reporting for medicine but continues writing, with a special interest in health. Amy is a founding editor of Croakey Health Media, a social journalism collective for health, and an aspiring ED generalist with the Victorian Rural Generalist Program, based in North East Victoria. In her spare time she is mother to two small kids, and angling for the ever-elusive ‘having it all’.

About Eloise Sobels

Eloise is a final year medical student at the University of Sydney, New South Wales. She is currently completing her clinical years based at the Royal Prince Alfred Hospital. Before embarking on her Medical degree, she completed an undergraduate in Medical Science (Hons) from Flinders University and worked in a Clinical Pathology Laboratory testing and reporting on blood results. Ellie has a passion for team-based medical care and is currently working on research into Multidisciplinary Team based care for End-Stage-Kidney-Disease patients. Ellie is an avid dog lover and enjoys any beach related activity, as well as playing hockey for the University of Sydney.

About Dr Rhea Liang

Rhea Liang is a General and Breast Surgeon on the Gold Coast, surgical educationalist, diversity in surgery advocate, and Chair of the Operating With Respect Committee of the Royal Australasian College of Surgeons.

What makes a good boss?

With General and Breast Surgeon, Dr Rhea Liang, junior medical officer with Victorian Rural Generalist Program, Dr Amy Coopes and University of Sydney medical student Ms Eloise Sobels

Introduction

In a discussion format, this podcast looks to explore to past, present and future perspectives on what makes a good boss in medicine.

Amy Coopes:  What is the role of a boss in medicine?

Rhea Liang:

• Willingness to step up and constantly expand your role.
• Medicine is leaning more towards versatile leadership. Someone who can pivot as required between the different types of leadership.
• Understanding that most times I am the most experienced in the room but recognising the times when I am not and finding someone who can fill that role.

Eloise Sobels:

• To make highly complex decisions around patient care and treatment options.
• Compacting complex information in a way that it easy to understand for patients and communicating that in a shared decision-making model.

Amy Coopes:  What’s defined a good boss for you both previously?

Eloise Sobels:

• The bosses that have stood out to me are the ones that make you feel part of the team, by introducing themselves, asking your name and even what year you’re in.
• Bosses that take the time to acknowledge you, remember your name, and perhaps even delegates a patient to you, those little things are really what makes you feel welcomed.

Rhea Liang:

• • Bosses who make space, who don’t feel the need to fill the entire space themselves.
  • They make space for other people, other ideas and for emotions. As when they feel the need to fill the entire space themselves there’s no more room left for other people, ideas and emotions.

Amy Coopes:  Do you perceive that being a good boss is different from being a good leader and if so how?

Rhea Liang:

• There are times when your responsibilities as an employer butt up against your responsibilities as a leader and I really struggle with that sometimes.
• With the past year of COVID19 and the bushfires, I think this is the time for exceptionalism not the time for following every process or policy. We have to make space for exceptions.

Eloise Sobels:

• The two concepts are certainly intertwined, in my opinion, a good boss is inherently a good leader.
• For me, leadership qualities include, understanding your team’s strengths and weakness, constructing the team around that and understanding that everyone has a valued opinion and different expertise.

Rhea Liang:  As a junior doctor and medical student, what are some things you’ve really appreciated in a boss?

Amy Coopes:

• They see you. They remember what it was like as a junior doctor.
• One boss made the effort to call me on my mobile and give me positive feedback on a discharge summary. It was so appreciated.
• People who remember what it was like in their junior years and remain connected to all levels of the hierarchy.
• Bosses who don’t consider themselves more than you just because they have more experience and recognise your value in the team.

Eloise Sobels:

• It’s the simple things that make you feel part of team – it’s welcoming you to the rotation, remembering the students name. It’s really just the simple things that make you feel part of the team.

Rhea Liang:  Have you met things that you thought the boss could have improved on?

Eloise Sobels:

• Acknowledging you are there is really appreciated.

Amy Coopes:

• When you see a good boss, you know, you think that should be the rule not the exception.
• Bosses recognising the stresses that you’re under as a junior doctor and that you’re very much still learning.
• There needs to be space made so that the boss is available to support you and give you advice around patient management but also regularly checking in with you about how you’re going, and I think a degree of pastoral care. I’d really like to see that be the rule not the exception.
• Every doctor from resident level to the most senior doctor should be involved in and have an interest in mentoring and fostering junior doctors. We’re the next generation of doctors and the same goes for medical students.

Rhea Liang:  Have either of you seen egregiously bad behaviour?

Amy Coopes:

• No comment.

Eloise Sobels:

• Yeah, I think I’ll leave that one alone as well.

Amy Coopes:

• Unfortunately, I would say yes, we see the enduring cultural problems in medicine. I saw and was recently involved with a discussion around this on twitter, where the thread was a testament that this type of behavior is sadly not a thing of the past.
• I’ve encountered it myself, not necessarily bullying or being aggressors but there’s a degree of low-level mistreatment. People letting the stress of the day and the job get to them and forget that you’re maybe making your first referral to this discipline and you don’t exactly know what you are doing and you’re just trying your best.
• Good feedback goes such a long way. We need to be told when we are doing things well because it not only helps with morale, but it helps you to continue to do the right things.

Rhea Liang: Now that you’re a junior doctor rather than a medical student, has what you appreciate in a boss changed over time?

Amy Coopes:

• I found being a medical student really hard, I just felt very superfluous and redundant a lot of the time and annoying as well. I didn’t really understand the scope of what I was doing, and you’re constantly torn between what I should be doing, ‘should I be in the hospital or should I be in the library studying for exams?’ Striking that balance is difficult.
• When you start working you have a different relationship with the boss. You are suddenly a person to the boss and to everyone else in the team. You’re not just ‘the student’ you’re a person whose got a name.
• Your expectations and needs change from the boss. You need them to answer questions, you go to them for support.
• Fundamentally what you think of as a good boss doesn’t change.
• It goes beyond a good boss or a good leader, it’s ‘what makes a good person?’
• Being the person that you are to your patients to your colleagues as well.

Rhea:  Ellie, you’re a final year now, so you’ve had some experiences with bosses on rotations?

Eloise Sobels:

• I wouldn’t say the qualities I’ve appreciated in a boss change. I would say my priorities and what I’m looking to gain from a boss is different as I go from year to year.
• Last year, in my first clinical year I was focused on clinical knowledge acquisition and I still am this year, but I’m equally as interested in understanding the job of a junior as this is my final year.

Rhea Liang:

• What I’m hearing is that you started off valuing their skills as a teacher to convey clinical information and then it’s later on you appreciates their role as a role model.

Eloise Sobels:  Outside of medicine, who are some examples of good bosses and why?

Amy Coopes:

• From my prior career in journalism, is a boss who was a great role model. He completely flattened the hierarchy in the newsroom and valued everyone’s opinion.
• Recognising and promoting diversity in teams is done well in a good boss. This boss was someone that could unite people from all different backgrounds towards a common purpose.
• This boss was just a genuine person and was someone who made social networking a breeze.

Rhea Liang:

• One of my great mentors still is the boss of the department when I first came over to the Gold Coast. I had worked three months as a consultant when I moved and met my boss. Back then I didn’t realise how unusual it was to have a woman heading up a surgical department, but she was just so reassuring and able to put you at ease.
• She also gave you wings to fly. She gave me the freedom to develop a fully-fledged breast unit. She told me to go ahead with it and she would try to secure the funding and would help with anything that I needed.
• It was this type of leadership that gets the best out of people. They see you as a package of skills and they are willing to let you make the most of what you got.

Amy  Coopes:

• Good bosses, they see potential and bring the best out of people.

Eloise Sobels:  Both of you have sort of commented on culture setting, what are your views on that?

Amy Coopes:

• I think that’s absolutely pivotal. It’s going to take a generation to start to turn the culture around in medicine and I see that already happening.
• It’s important to see more female leaders coming through because it gives a different perspective and different nuances around family and work-life balance.
• Those nuances matter to people and matter to the longevity for a career in medicine. They provide for well-rounded doctors as well.

Rhea Liang:

• In the day to day, it is about starting conversations but it’s also the principle, ‘nothing about me, without me,’ and so it’s hard to have those conversations when there is literally no one on your team who is a person of colour or who is queer. Are you going to talk about it without their perspective?
• That is our problem in surgery, which is still 87% male. It’s about getting those voices in a room, otherwise we can’t even start having those discussions.

Amy Coopes:

• This issue goes beyond medicine and we’re leading in kind of a bad way I think.

Rhea Liang:

• Yes, and it’s about the patients we look after, our patients come from all walks of life and are diverse so how do we think an un-diverse doctor population is going to understand their needs.

Amy Coopes:

• And let alone engage with the system. There are certain minority populations that get labelled as non-compliant and loss to follow up and is there any wonder why that is? No, absolutely not. I absolutely see how people don’t engage with the healthcare system or mistrust the healthcare system because they’ve had really poor experiences. Part of informing that not happening is having those voices at the table.

Rhea Liang:

• Just simple things, the other day I had one junior doctor come up to me to say that a patient didn’t get their prescription filled and the gap was only $13. It was hard in that moment to say that $13 is dinner on the table.
• Clearly the person who’s talking has had the privilege of never having to count their dollars. That starts really early, and we can delve into medical school and how we select people for medical school. If, this person had someone who was from a low socio-economic background in their medical school then perhaps they might have already had that discussion.

Amy Coopes:

• I agree with you Rhea, but I also have had so much experience in doing the heavy lifting for people, educating on why this is problematic and why you shouldn’t talk like this and why you shouldn’t hold these views.
• I don’t know how we get around this problem, but I think it some of it comes back to leadership and calling out that behavior, setting the standard and creating the culture.
• As a leader, engaging in these conversations and doing it in a non-judgmental way.
• Having these conversations early, in medical school, as a junior doctor, because the longer we don’t say something is how that culture perpetuates.

Eloise Sobels:  If you had some tips for new consultants what would they be and why?

Amy Coopes:

• Calling people on their problematic views.
• Being careful with this, but also calling out patients for problematic views and standing up for your colleague at work.
• Being courageous, having values and unapologetic for who you are.
• Mentoring and being a role model and seeking this out.

Rhea Liang:

• I would echo that. All through my training I received feedback that I wasn’t enough of a surgical boss and that I had to be bitchier, I spent too long talking to people, I was too nice and that others would take advantage of me.
• In retrospect I realise a lot of that was wrong even though it came from a good place.
• There is a role for a lot of diverse models, some people in society really like an authoritative surgeon who will tell them what they’re going to do because it removes that cognitive load, they may not like my style which is much more collaborative where I say, ‘these are some options, what are your thoughts and how can I help balance that with your cancer treatment?’ Some people find that when they’re in a very difficult circumstance to have someone decide a treatment plan for them and that’s fine, so we need to provide all of that in our profession. We don’t have to expect all us to each be all things to all people.
• But the problem is historically we couldn’t be all things to all people, we only had one model. So, I would say to people coming through, don’t be afraid to be yourself, make a new model.
• That saying, ‘you can’t be what you can’t see’ is not entirely true. It’s harder to be what you can’t see but someone has got to be the first so make a new one!
• Harness the early energy. You have so much on your plate when you’re going through medical school and as a junior doctor that you will be full of ideas about what could be done better.
• I’d encourage you to keep all of those thoughts because when you come out of your training as a boss and you start to have the power to change some things then all those ideas can come to the fore.
• If you’ve been too enculturated or socialised at that point you might have had all those ideas banged out of you. So, write down more of those thoughts because they become very usual later on.

Eloise Sobels:  Both of you have thousands of twitter followers online, how do you deal with that kind of exposure and has that changed the way you go about your current positions?

Rhea Liang:

• I feel like a bit of an imposter and I know imposter syndrome is a thing and we must talk about it, but I’m a relative newbie to twitter having started on it two and a half years ago and I can only really manage the one platform, so I think Amy is much more cleaver with this than I am. It’s been quite a steep learning curb!
• It’s been a space for positive influence beyond your own workplace. For a whole decade I was the only female general surgeon on the whole Gold Coast so of course I’m the ‘oddball,’ and it’s only really been since I’ve gotten onto twitter that I realise there’s at least one other person per department who’s sharing these same thoughts.
• All of us might feel a bit alone in our departments but I tell you that over the past two and half years I can see that voice is growing.
• I made couple early editorial decisions that I wouldn’t post identifiable pictures of the kids. The kids feature but I wouldn’t disclose their identity online until they were old enough to decide that for themselves.
• The other thing was that I wasn’t going to separate my personal life. A lot of people have a professional account and a personal account. But I thought it’s important to role model who you are a whole person because in real life those two can’t be separated. All things that I do outside of my paid work influence my paid work and it allows me to connect with my patients as well.

Amy Coopes:

• People like to connect with who you are.
• I’ve gone through lots of phrases in my life through twitter. When I used it as a journalist, I was very public facing about who I was and then I got really burned by that one time. That was a good wake up call for me and my boss at the time said, ‘don’t say anything of social media that you’re not prepared to say in front on a TV camera.’
• I don’t think they’re comparable, talking in front of a tv camera versus behind a keyboard but sometimes it’s liberating for people to have conversations that they might not have otherwise had. Then when I was a student again, the reigns were off, and I found twitter in medical school to be a fantastic place to connect with doctors and like-minded people.
• I’m in another phase now, I’ve started working and I’ve been talking about some of the things I’ve found problematic and people started coming into my DMs and saying, ‘you need to be careful,’ they meant well and weren’t trying to censor me but to just tell me their stories of how they were brought before ethics committees at their hospitals and asked to explain which made me angry.
• But as doctors we have to be careful not to bring the profession in disrepute because there are consequences for that where it can undermine the trust within the patient-doctor relationship.
• I’ve now come back to curating my thoughts in a way and not censoring myself but just being careful about how I word things and the implications of how I talk about things.
• You have to remember that your audience is your colleagues but also the general public as well.
• We need public trust in our profession because that is how we defeated the pandemic, and I know it’s not over yet, but the vaccine is rolling out and we have for now escaped the suffering seen in other parts of the world.

Amy Coopes:  If you had a few take-home points for this podcast what would they be?

Eloise Sobels:

• A good boss and a good leader are intertwining concepts and by developing one aspect you’re developing the other as well.
• You shouldn’t be afraid to be different and don’t be afraid be a reflection society even if it’s not in our medical system just yet because you might be the one who is trailblazing that path.
• Be flexible in the way you lead, be open to other points of view and be conscious of the societal changes around you.

Rhea Liang:

• It’s all the simple things. Like knowing your medical students name, including them when they turn up and seeing your junior doctor and thanking them.
• You don’t have to be all things to all people. It was reassuring that you just value the simple teaching about clinical knowledge, which I think all of us can do.
• It’s the little, everyday leadership that makes a lot of difference to people. Simple things, like teaching you. We don’t have to hold leadership as this far away, el dorado, we can all do it right now.

Amy Coopes:

• Everyone can be a leader, it’s about being a role model, it’s about living your values.
• I think the main thing I’ve gotten form this podcast is that Medicine is in safe hands. We have these amazing women who are stepping into leadership positions or aspiring to leadership and I think the more diversity we have in every facet of medicine the better off we’re going to be. I feel hopeful that, that is something that is slowly but surely taking place.