My Career

I loved school and was reasonably bright, so did well in exams and matriculated with good scores. I applied to study Medicine at the University of Adelaide - not for any particularly altruistic reason or even because I felt medicine was meant for me - but mainly because I had studied mostly science subjects at school and I wanted to pursue a career that would make Mum and Dad proud of me. I won a Menzies scholarship which paid course fees, gave me a text book allowance and a fortnightly living allowance ( means tested against Dad's income) for the full 6 years of Medicine. Without this, there was no way I could have gone to Uni.

I had loved Latin at high school and wanted to do it as my elective in First Year at Adelaide Uni - I even bought the texts - and then to my horror, I was informed I would be going to Flinders Uni. It transpired that the top group of students accepted into medicine were being sent there to get this brand new Uni up and running. No electives there and my dream of continuing Latin was dashed. Flinders was ghastly in those days - a bleak site with a few modern concrete buildings, hardly any trees or pleasant scenery and a barren windswept walk by the lake from the science block to the refectory and library.  I hated it - but Dad did up firstly an old Vauxhall, and later an Austin A40 for me and I could drive, taking various friends with me. I remember the tutors and lecturers as incompetent  - in some exams we all did so poorly that the pass marks were downgraded to push us through. After all, this brand new educational facility couldn't tolerate the prospect of the best students selected for medicine failing! One good thing about being at Flinders was meeting John Owen who was repeating first year there. I became good friends with his mother, Kath, who sadly died from multiple myeloma a few years after we all graduated.

Eventually my year there was over and it was off to the Uni Adelaide Medical school from Second Year on. I have referred to some of the fantastic mates I met during this time in the page "Special Friends".

Uni life was a trial for me at times - I had been used to discipline and structure at high school and found it hard to motivate myself to study. Plus I didn't really enjoy what we were being taught. So much of medicine seemed to be learning things off by heart in order to mark the correct box in a multiple choice exam. Anatomy classes were particularly stressful - I didn't mind the cadaver but I found my dissection skills were not as good as they should have been. I was pleased when the other guys in my group took over.

When we started to actually meet and talk to patients in the clinical years, it all started to make more sense but even so, I often wondered whether I had made a mistake in my choice of career. I think these doubts contributed to my early marriage and preganancy - maybe unconsciously looking for a way to opt out of finishing the course. But at some point a "survival" mechanism kicked in and I realised it would be a terrible waste to sabotage myself by giving up. I was lucky to pass 5th year - I was home with the baby one day when a knock at the door led me to discovering that I was due to attend a final viva in paediatrics that day and one of my consultants was worried when I hadn't turned up, She had despatched an assistant to collect me and Joshua and rush us the Childrens Hospital where she cared for the baby while I stumbled through the exam. How or why I had failed to correctly note the date and time of my viva I don't know, but I remain grateful to the consultant for her concern for me.

I hated most of my intern year - I felt so inadequate and worried all the time that I was not a good doctor and was doing harm to the patients. But I was rostered to a "relieving" term - and ended up in ward 3C, the psychiatric ward at the Royal Adelaide Hospital. Something clicked and for the first time, I began to believe that I might find a role for myself within medicine that suited me. The event that really turned me on to psychiatry was seeing one of my patients - a profoundly depressed, suicidal man make a spectacular recovery with ECT (electro convulsive therapy). I know this treatment is much maligned but my word, it worked a miracle for him.

The only other specialty I had considered was plastic surgery, mainly because I enjoyed the fine needle work involved and the attention to detail which produced great cosmetic results with minimal scarring. But this was 1974 and women had no place in surgery, according to the senior surgeons in all fields.

I went to The Queen Elizabeth Hospital for my resident year and obtained another term in psychiatry (at Enfield Receiving House). This confirmed my interest in psychiatry and I then applied for the training programme. In 1976 I was accepted as a trainee in the (University) Dept of Psychiatry at TQEH and spent 7 mostly happy and fulfilling years there, gaining my Membership of the Royal Australian and New Zealnd College of Psychiatrists in 1979, advancing through senior registrar ranks to a consultaant position. Obviously there were difficult times - the workload sometimes seemed enormous, the teaching of medical students expected by the University could be onerous ( although I enjoyed contact with the students themselves) and the nights on call could be frantic. By now I had left my husband, Brenton and was living in the Connor Building - the doctors quarters at TQEH - so at least I didn't have far to go to answer calls to the ward or the Emergency Dept. (I had a little flat where I was able to create a second bedroom so on weekends when I wasn't on duty, Joshua could come and stay with me - in fact we had some great birthday parties for him in Connor.) One of the lasting friendships made in ward 9B was with the charge nurse, Elvene - see "On the Murray" - a vivacious, sparkling woman who could make the busiest day better. See "Special Friends" for more information about other great friendships from TQEH days - Jane and Kate.

During this time I completed a Diploma in Psychotherapy through the Uni of Adelaide. (it has been said that Adelaide general hospital psychiatry was obsessed with psychotherapy as a treatment modality and the consultants would "analyse a piece of string" if they could!). But I certainly found the less Freudian styles of psychotherapy I learned to be quite useful tools not just in dealing with patients but in managing staff as well.

I became disillusioned with the University control of the psychiatric services and promotional prospects at TQEH - I was more interested in clincial work than academia and research and felt the senior staff were not sufficiently interested in sustaining a healthy ward environment for patients and junior staff. With our social worker, Pam Nye, I put together a therapeutic day programme for the patients and persuaded the hospital administration to spend money on new furnishings for the ward - with little thanks from the University seniors.

In 1984, I took up the position of Director of Psychiatry at the Modbury Hospital - although I loved working with the trainee psychiatrists rostered to the ward here, the paucity of other consultant presence and the conflicting demands from Modbury Hospital management and Hillcrest Hospital management ( which wanted to run the ward as an outpost of Hillcrest) were a bit wearing. In 1986, I was pleased to obtain a consultant position at Glenside Hospital. All my experience till now had been in general hospital psychiatry and it was a challenge to adjust to working in "a bin" as the mental hospitals were called in those days. The patients were more disturbed and required different skills (analytic psychotherapy was not one of them!), some of the nurses were still "warders" in their mentality and approach to the patients, the wards were often quite run down and it could be difficult to attract trainees and new consultants to the hospital.

My happiest years in clinical psychiatry were spent in Brentwood - the 'intensive care unit" of Glenside where I was the Director of Acute Services and the chief consultant. These patients were the most seriously ill and demanded a great deal of expertise to safely control their psychoses and suicidal or violent behaviour. There were wonderful nurses in this ward, excellent social workers and an amazing psychologist. We really functioned as superb team, and I like to think we did a lot of good. (While at Glenside I met and married my second husband, Eion who was a firstly a clincal nurse and later an Assistant Director of Nursing).

While I had been at Modbury Hospital I developed an interest in the administration of hospital services and the management of staff. Between 1987 and 1990 I undertook a Graduate Diploma in Business (Health Service Management) at the University of South Australia, being permitted to attend lectures and tutorials during working hours if there were none scheduled for out of hours. Some subjects were completed during my annual leave periods if they were offered as intensive "summer schools". The downside of this study was a growing realisation that medical staffing  and development opportunities for trainees at Glenside were not being managed as well as they could have been and a rift evolved between me and the hospital's senior medical manager. Maybe that's to be expected as he was the same man who had headed up the University Dept at TQEH and he was not much of a manager there either. But I confess the story so far sounds as though I am an ungrateful disloyal employee who finds fault with her superiors.

The opportunity arose for a medial adminstrator appointment at a new hospital at Noarlunga and I was fortunate enough to win the job. Here I met the best boss I ever worked with (Paul Gardner) and for the next 4 years we put together a well functioning if small, community hospital. Stupidly when I was offered what was supposed to be a managerial post back in mental health services, I took it. I ended up doing a lot of clinical work again because of staff shortages and became Chief Psychiatrist for South Australia - if that sounds like the pinnacle of my career it was a sorry one. We were required by the National Mental Health Plan at the time to effectively dismantle the mental health services and "realign" them with general hospital services. There was great unhappiness and unpleasantness among staff of all disciplines and the end result can only be judged by those who were watching over the next 10 years - I think it was a poorly executed and somewhat cynical exercise but others are apparently pleased with the outcomes.

What it meant for me was no position in the new arrangements and I was sent into the SA Health Commission which was going through a particularly mad restructure (purchaser/ provider split) where my role was ridiculously ambiguous and even included things like managing elective surgery! I asked for a halftime shift back to the mental health component of the Royal Adelaide Hospital where I became quality coordinator, which was actually good fun. Eventually someone "discovered" that the funding for my position had ceased to exist when SAMHS was disbanded and I was declared "surplus to requirements". This is a ghastly way to destroy an individual's career identity and morale. After 3 months of sitting in an empty office doing nothing, I accepted the offer to return to Noarlunga, this time as a full time clinical psychiatrist. It was not a job I relished but at least I was productive and working with pretty decent people. However, my disillusionment with psychiatry was compounded by the revolving door patients with drug induce illnesses - this was not the sort of practice which had inspired me during my days in Brentwood.

In 2001, Paul Gardner who had continued to be the chief executive of Noarlunga was sent to the Lyell McEwin Hospital to try to salvage it from the ravages of yet another political fiasco - the LMH had been merged with TQEH some years earlier and the reality that this was a debacle had finally been appreciated. He remembered me as a medical administrator with whom he had worked well and arranged my secondment to the LMH. In time I won the position on merit - the next 5 years were the most enjoyable and fulfilling of my adminstrative career. I believe we changed the ethos of the Lyell, helped its staff achieve their potential and set the benchmarks in a number of areas including clincial risk management, development of meaningful quality improvement activites, the credentialling of medical staff and innovations in clinical services. That we were in a hospital which was, after years of neglect, gradually being rebuilt and modernised in its physical structure was of course, a great boon.

But, good things never last - governments are always trying to fix things which aren't broken, especially in health and now we were faced with the establishment of area health services and the loose amalgamation of hospitals (again!). In my opinion, the Central Northern Adelaide Health Service was the greatest abomination ever inflicted on South Australian health. It seemed that the Lyell was "punished" for succeeding - the chief executive and the finance manager were seconded into the Commission and replaced by incompetents. The leaders in CNAHS clearly devalued medical adminsitrators and reduced the number servicing 3 hospitals from 4.5 to 2, and then asked the 2 of us to manage two hospitals each. They completely failed to realise that medical (and other staff) need a full time medical admin presence to maintain the impetus to proper systems, clincal risk management and quality. It became apparent to me that I could not sustain a high level of service to either of my hospitals, one of which was privately managed. When the government decided to bring that hospital back fully into the public domain, I was relieved to go there full time even though it meant losing all contact with the Lyell which I had grown to love. At least full time at Modbury there was a chance I could again assist medical staff to make the transition back to the public realm in a way which improved their conditions and enabled them to fulfill communtiy expectations of a quality health service.

My naivety never fails to amaze me! Within a year it was obvious that CNAHS was infected with a micromanaging, bullying style of management which it had learned from the new Chief Executive of SA Health ( formerly the Commission). No longer could I take a decision which would benefit the hospital without referring it up through a tedious line of management and awaiting it to come back down to me. Even where a funded position was vacant and I had previously been able to exercise sensible actions to fill it, I was now forbidden to do so without an imprimatur first from CNAHS and then from SA Health. In the meantime, hospital services were undermanned, or staff were working extra shifts and overtime to try to fill the gap. The final straw was being told that yes, my office needed extra clerical support for the recruitment, appointment and rostering of medical staff but it did not need me! Any senior clinician with a patient and departmental load could do my job as well as his/her own, according to the external consultant employed by CNAHS to investigate the staffing in my office..

And so my life as a medical practitioner and adminstrator in the public health system of South Australia ended in 2008 with a bout of major depression and a 10 month leave of absence during which time I agonised over my weakness and inability to "get on" with the new systems in play. It took a long time to realise that I did not have to prove myself by going back to work in the current environment of CNAHS and SA Health. If I valued my sanity and  well being, I had to retire, which I did formally in early 2009. I had once descrtibed CNAHS as a "folie a famille" - a powerful but psychotic member of a family drives everyone else in the family into madness as the only way of coping - I now think the same description applies to SA Health. In the end the only way for an individual not to go crazy working for it, is to get out.

Post script - when I returned from my long holiday to the UK and France in 2010, I was fascinated to learn that the area health services, including CNAHS had been dismantled but replaced by one overarching health service - shades of 40 years ago! Alas, the prime movers in CNAHS have been elevated into this larger structure and the bully in charge of SA Health remains there!

Further postscript - January 2011 - the bully has been promoted to a national role (OMG!!) but his legacy lives on in South Australia. When I meet friends who are still working they continue to describe micro-management, staff demoralisation and decisions made for financial reasons with little regard to clinical necessity. I certainly have no regrets about retiring.