Canberra Day 94

[Wednesday 14th December]

Well today was a terrible day career-wise, nothing fatal but nothing fun, so it’s a good thing that I’m in Canberra with a licence to explore and enjoy new experiences.

I’m having some issues with the Australian Health Practitioner Regulation Agency (AHPRA) that manages the registration of 14 different health professionals, including pharmacists. Previously we had our own pharmacy board, but in 2010 several boards were amalgamated and now we are managed jointly. This new organisation, AHPRA, manages our annual registration including our compulsory continuing professional development (CPD) requirements, whilst another organisation manages the regulation of pharmacies and pharmacy departments. All very boring and tedious, until your annual registration comes up against a problem. In my case a CPD problem. Each year between October 1st and September 30th, every registered pharmacist in Australia now has to achieve 40 hours of CPD to qualify to be re-registered. After the amalgamation the amount of CPD to be achieved began as 20 hours and increased over a couple of years. Its pretty standard now, and pretty achievable if you’re working, which is the point; to keep you up to date.

I first went on sick leave in March 2014 and stayed on sick leave for several months before I dragged my reluctant body back to work only part time for 6 weeks in September/October that year to complete my contract at the Alfred, in the vain hope that I would build up professional fitness quick enough to convince my workplace that I was fit and well to work and be re-hired. I was desperately hoping to stay on because I loved that job. It was a joke looking at it now; there was no way I was even fit for the very part time work I was doing then let alone more. But the point being, between October 1st 2013 and September 30th 2014, the annual CPD year, I worked 6 months and work generates CPD as does starting a new job as does changing positions within a job all of which applied to me. So even at the 6 month mark when I got sick I had oodles of CPD numbering probably around 50 or 60 hours. So I finished my feeble 6 weeks in dispensary, ended my contract and went back to bed.

By the time I got going again and went back to work, it was July of 2015. Already up to 9 out of 12 months of the CPD year, and to be honest, to this point CPD hadn’t even crossed my mind! A little teensy nervous breakdown and the associated issues had occupied the major part of my brain for months on end and work had just gone away. Even now returning to work I was conscious of the need to get up to date with the many new drugs and devices that had hit the market in the last year and a bit, but I hadn’t thought particularly of my CPD requirements with respect to my registration. I did all the required new job CPD, I did study on things that were relevant, I recorded it all and never really thought of whether I was making the 40 hour amount. Which is unfortunate, because I didn’t make it! I got 25 hours, not 40.

And there is no clause for people on sick leave. Or for people not working. You’re either practising or not practising. So, in November 2015 when I was re-registering as a pharmacist and got to the compulsory question about whether I had completed 40 hours in the previous year, I had to answer in the negative as in I did NOT meet the CPD requirements. And I won’t say that all hell broke loose, but all kinds of official pharmacy correspondence started flying around the web and through the postal service, and today is just another step in the painful process that is rectifying the situation! I’m not complaining about having to fix this up; I should have to. I’m a health professional and patients need to be sure of me being up to date and on top of the latest drugs and professional practice. I’m just complaining about the amazing bureaucracy that prevails in these matters! It is not easy to show that you have done your best to fix it, that you’ve learnt your lesson, and that you’ll do better in the future. Especially if you’re out of work again, because things just don’t come up when you’re not dispensing and reviewing medications on a daily basis. You have to actively look for things, and it’s just harder. But it’s part of my commitment and I have to just get on with it. So I’m off to send yet another email, which will probably get yet another “out of office” reply, followed by an actual reply sometime in the next two weeks or so telling me that there’s yet another technicality that I haven’t met because I was never told about it, followed by another email from me phrased very conservatively despite my inner rage and so on. You get the drill!

So there’s that, and following that the awful words “we’re terminating you”!! Seriously?! I went back to work officially in June 2015 with a fixed term 9 month contract. I guess I always assumed that there would be a possibility for extension at the end, assuming they liked me and my work was up to scratch etc. But no, despite putting me through two traditional interviews and a non traditional observation of practice interview I was never successful in getting an extension. So I was told I would be put on the casual list and they’d call me, which they never have but that suited me lately being in Canberra and all. So now out of the blue I get a call to say sorry, it’s just a HR thing but because you haven’t worked for us in 3 months we have to terminate you!! I’m sorry, what?! I’m costing you zip, I’m (usually) a resource available at short notice a 4 minute walk away, and if this was always a HR thing, why didn’t you just say goodbye at the end of my contract, instead of giving me an impression that I’d be called up to work?? So when I get back I have to return my keys and it’s all over. Well what a wake up!! Could this day get worse for my career?

Luckily I have good things planned so let’s off to the High Court to observe other people getting the rough end of the stick, potentially. I won’t pretend to understand the case that was being argued but the solemnity and the ceremony of it all was very impressive and the two counsels arguing were humorous in their own way, especially one who referred to “my learned friend” at the beginning or end of every sentence! I’m pretty sure even the 5 judges were smiling under their wigs. A bit of light relief, and I’m glad that becoming a lawyer was never on my list. I took my fill then left, remembering to pause and bow to the judges on my way out!

And now to really flush all that career mess out of my system!! I’ve been looking forward to this christmas concert by Igitur Nos at the National Library for a couple of weeks now. Turns out it wasn’t quite what I was expecting…more classical music, Latin and high brow Christmas songs than your typical carols. But it was pretty nice. Then a drive by a few places of interest: the historical and very pink Calthorpes House, and a few embassies.

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Lucky I have a lovely catch up with a friend after lunch. Nothing so soothing as hanging out with a friendly face and chatting away the afternoon. A super cute little baby helps just a little bit too! Happy day…in the end.

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“Totally incapacitated”

Here’s one of the perks of being a health professional.

When the tables are turned and I find myself on the other side of the bench/bed/clipboard, I can understand the language.

When a doctor, nurse or other health professional forgets to translate the Greek/Latin into English I still know what they’re saying.

I know the medical terms. I know the diagnostic criteria. I know the treatment plan. I know the drill.

Because it’s my language, usually.

“Take these tds. Experiencing anhedonia. Query gets elevated. Ruminating. Appropriate. BP1”

I spent years learning all the terminology so that complex medical information can be quickly and easily communicated to other health professionals. And then spent years of practice learning how to translate it back in a simple, un-involved way to patients and non-health professionals.

So now, when I see a doctor it doesn’t matter whether they use the Greek/Latin or English; I can understand.

This has its downsides.

Sometimes doctors use Greek/Latin code to communicate sensitive information amongst themselves that the patient doesn’t necessarily need to know at a point in time. Information that may have a negative impact on the patient. Information that may alarm the patient unnecessarily. Information that may skew the way the patient sees themselves and reports information to the doctor. Or many other reasons.

Patients don’t like this most times. They want to know. They want to be told. They want the translation of doctor-speak.

And so they end up asking for information that is unnecessary; that will later prove to be irrelevant; that scares them for no good cause; that gets them looking for specific signs and symptoms that may not be there and creates a degree of paranoia; that gets them reporting biased information to the doctor instead of giving the full range of  information that the doctor needs to determine a diagnosis or treatment plan.

For example a patient comes to the doctor with a dry cough that has been going on for a couple of months.

In the doctors’s mind the common causes are viral, post-nasal drip after a cold/flu, or chest infection. The less likely causes may include tuberculosis (TB) or lung cancer. But of course no doctor will tell a patient who has just walked in to the surgery that they may have lung cancer or tuberculosis. That would create panic, scare them for no reason and bias the patient to give information that they think is related to lung cancer or TB. It would create a lot of emotion that would take a long time to deal with and is unnecessary.

Instead the doctor runs through a series of questions to rule in or rule out different diagnoses and comes to a conclusion, makes a diagnosis and comes up with a treatment plan. Without causing bias or terrifying the patient by telling them the options that they are ruling in and out. Without giving them unnecessary or irrelevant information. Without telling them information that somehow they think they need to know.

They communicate the diagnosis and treatment plan and send the patient on their way.

(This is an example only and not a comprehensive diagnostic description!)

The unfortunate thing about knowing the language is that I get these sensitive bits of information. I get information that I don’t need, that may end up being irrelevant. I get information that scares me, that changes the way I think about myself and the way I look for symptoms. I get information that is more than I can handle, that weighs me down.

Here’s a translation of the terms above:

“Take these tablets 3 times every day. The patient is suffering from an inability to experience pleasure in, or enjoy, day to day life. There is a possibility that the patient suffers from episodes of mania including high energy, extra happy moods, enhanced appetite, lack of judgement and self control. The patient is experiencing circulating thoughts on the same subject that keep going around and around and prevent other thoughts. The patient is behaving in a reasonable manner and is not demonstrating any unusual symptoms. Bipolar 1 disorder, otherwise known as manic depression where a patient can experience episodes of severe depression and then alternatively experience manic episodes of high energy, excessive behaviour and ultra happy moods.”

So you can see why health professionals are taught Greek/Latin!! It makes communication so much simpler and easier. Saves a lot of talking in critical situations.

But for me, instead of hearing a few blah blah words, I get the whole lot dumped into my brain. Which is a lot of information. Especially about things that aren’t confirmed and are only a “query” or possibility. It changes the way I scan myself and look for symptoms. It changes the way I think about myself. It confirms the negative symptoms. Sometimes it confirms that I’m doing okay. Sometimes it confirms ‘maybes’. Sometimes I just don’t want to know!

A few colleagues have said to me at different times: “so what antidepressant did you choose?”

I guess it’s a tendency of health professionals to semi-diagnose themselves, think out a probably treatment plan and consider the pros and cons before going to another health professional, usually a doctor.

But that’s just not how it has been for me. I got sick. I felt awful. I got desperate.

So desperate that I just wanted to put myself in someone else’s hands, to not have to take care of myself anymore, to give the responsibility over to someone else.

I didn’t want to think about treatments, I didn’t want to know about the decision making process, I didn’t want to have the burden of deciding which antidepressant was most appropriate for me, a 26 year female of child bearing age with irritable bowel syndrome, reflux, previous clotting disorder and high blood pressure while taking an SNRI, venlafaxine, exercise-induced asthma, previous failure of therapy while taking an SSRI, fluoxetine, feeling suicidal despite taking 2 antidepressants for the prior 2 months.

I didn’t want the knowledge. I didn’t want the automatic analysis that I’m trained to give to any clinical scenario. I didn’t want to have to think it all out. I just wanted someone else to figure it all out and fix me.

So my message: think before you ask for knowledge, before you demand a translation from your doctor. Do you want the knowledge? Will you be able to handle it? How will it affect you? Do you really need it?

Or is it better to sit back, trust the doctor, and believe in the treatment that they have tailored specifically for your personal characteristics?

I’m not suggesting blind faith, or unearned trust but my recommendation is to think about what you ask of the doctor. Because they do have to give you the answer, even if it will only harm.

Because some words you can’t un-hear or un-read. Like when a doctor writes an insurance report for your income protection payout and gives it to you unsealed because you understand this stuff. And you read it and the reason he’s written for you not being able to return to work is that you are:

“totally incapacitated”.

That will hit you like a brick! It will make you re-evaluate your progress and current state of sickness/wellness. It will get you wondering if you are actually worse than you thought. It will get you wondering if you are useless.

It will start a chain of self-doubt and pondering. Suddenly you’ll think “can I” instead of “I can” or “I will”.

Am I actually a capable person who lives and breathes and cooks and cleans and drives and makes decisions and has responsibility?

Or is that a delusion? Am I actually not doing anything at all?

KNOWLEDGE IS POWER.

But can you manage the power or will it overwhelm you?

BE CAREFUL WHAT YOU WISH FOR.

Are you wanting to know details that can have no advantage or benefit to you, and are best left well alone to someone else’s responsibility?

Take it from me, if you will: you may save yourself a load of stress and anxiety, sleepless nights, fretting and worrying by leaving be details that will only weigh you down.

Let alone and be free.

wooden boat on an Amazon tributary at sunset

Peaceful serenity at sunset in the Amazon Rainforest near Puerto Maldonado, Peru