Michael is an accomplished anaesthetist with extensive medico-legal and medico-business experience. He is currently serving as the Head of Obstetric Anaesthesia at Norwest Private Hospital in NSW, the Managing Director of AccessMed Australia Pty Limited. - a company that allows patients from China and other countries to source the first-class medical and surgical care for which Australia is renowned - and the MedicoLegal Consultant at MWD Levitt Pty Limited. He is often called to mediate industry dispute between anaesthetist groups and hospital management, on top of his busy day-to-day anaesthesia practice.
I was very shy in the early days of high school. I realised I wasn’t happy about it and I decided to do something about it. So at age 15 I decided to remake myself into a stronger, more social and more self-confident version of myself.
My evolution had some benefits in meeting more people. It was a fantastic period in the 1960s (when Michael was in high school, and also the era of ‘sex, drugs, and rock ’n’ roll’) and through meeting lots of people I ended up managing bands. One of the bands was called Peanut Butter Conspiracy - they were never anything remarkable but we used to run gigs around town and had a lot of great times. The more people I knew and the more bands I managed, the more friends I had. I never looked back after that and it gave me a lot of self-confidence which I didn’t have at a younger age.
I became known as a natural leader and became a prefect at my high school. I went to Normanhurst Boys’ High School (a selective school in Sydney). I used to be president of my local youth group and in the Jewish circle. Throughout my life, people have approached me to take on things and lead things. I can honestly say that save for one occasion, I’ve never actually formally applied for any position that I’ve had.
If people want to succeed in medicine or business or anything really in life, you’ve got to be engaging with people. You’ve got to like people.
There’s an adage about who gets the jobs in medicine, and it’s not the most skilful person or the one with the highest marks. It’s about availability, affability and ability - in that order.
I have been on selection panels for people applying for medical jobs. They have got to be A.) available and not mucking around, and B.) be people that you want to work with every day; Nice people that you can relax and have a joke with. Ability is very important but that comes third. The first two traits are more important.
Communication is very important in life and your profession. If you can’t engage people and you can’t convince people to follow the path you want to follow, then you won’t succeed.
Everything in my life is by accident. I was always going to be a surgeon. I trained as a medical student and intern at the Royal North Shore hospital. I was doing a rotation in Mona Vale and I got on really well with a couple of the senior surgeons from Sydney Hospital there at Mona Vale. They told me, “Come to Sydney Hospital next year and you’ll get on the surgical training program.” So I applied to Sydney Hospital and got onto the surgical training scheme. I stayed for a couple of years and did a bit of advanced surgical training, including a term as a surgical registrar up in Tamworth. I decided that I didn’t like it, and at that time I was getting on really well with the anaesthetist.
I concluded that surgeons really only did two or three procedures. No matter what speciality, they specialised in two or three procedures. God forbid you should be a colonoscopist, you’d be doing that for the rest of your life.
I then took a year off and during that year off I found a job posting in the Sydney Morning Herald for the position of relieving casualty director at Parramatta Hospital. The casualty coordinator was taking six months long service leave. I was interested so I applied for it and I got it. This was the one and only formal job application that I have done in my life and I got it.
I started in early January of 1977, and a few days later we had the Granville train disaster where a train derailed and crashed into a street bridge in Sydney with countless severe casualties. Parramatta was the closest major hospital, so I was suddenly in charge of this major trauma event.
Apparently I did all right because I was approached by all these anaesthetists afterwards who told me “You’ve got a great career ahead of you. You should do anaesthetics. Westmead Hospital is opening next year and we’d like you to apply for one of the anaesthetic jobs.” So I followed their advice: I completed my one year term in Parramatta Hospital and then around August Westmead Hospital - a brand-new large teaching hospital - opened. The Director of Anaesthetics and two of the other senior anaesthetic consultants all backed me into an anaesthetics job: There were 74 applicants and four openings, and I got one of them. The rest of history.
If you get too emotionally involved in disasters, you can’t function at your optimum level. Whereas if you can step back and analyse a situation and do what is necessary, you will achieve better outcomes. What follows is that you are perceived to be more skilful and in control, and people will look to you as a leader. I joke about it all the time with all the surgeons I work with regularly that I’m not very strong in the empathy department.
It’s not to say that I’m not empathetic in my personal life but I could probably be better. I mean the price of all the things that I have done and do is that I have been divorced twice. Personal relationships get put on the bench when you are doing so many other things.
On the job it’s an advantage that you’re able to step back and look at the overall picture, rather than get preoccupied with a single ‘factor’ like the injured family of a mother, three children and a dog for example. You end up getting swept away by the emotional aspects of things rather than doing your best to stop her from dying.
Empathy, you either have it or you don’t. I don’t have it unfortunately. I’ve never had it and it probably cost me in my personal relationships. But it’s been a great advantage to me in my professional life.
We’re all flawed individuals. There are always things that you look back on and thinking, ‘Well I should have played that differently.’ You can be self-critical but you shouldn’t let it get out of hand. You don’t want to beat yourself over your mistakes too much. I think everyone will make mistakes in whatever career they pursue; everyone will encounter near-misses and disasters.
I was counselling a few registrars about this a couple of Fridays ago. As long as you perform to your utmost and tried as hard as you could in the pursuit of your desired outcome, you should not beat yourself hard about it, particularly if the result was satisfactory. You should actually be quite happy and proud if it was a near miss but you fixed it. Otherwise you’re going to become depressed and you won’t be able to function. The constant sense of inadequacy is one of the reasons why particularly in anaesthetics, critical care medicine and dentistry, suicide rates are particularly high.
You have got to be proud of what you have achieved in your journey and learn from any mistakes you learn along the way. Young doctors are inevitably going to make a lot of mistakes. I sure did in my younger days, I can’t recall the exact mistakes I made but I’m sure I made many of them. The trick is to recognise them, recover from them and learn from them. If you can do that consistently then you’ll become a great doctor.
The medical training system is much tougher now than what I experienced when I was going through.
I’ve been involved with selection panels and you’re often not allowed to choose all the best people. Rather you categorise candidates into three broad groups: the top academic group, the middle group, and those that we have to give a job to but we don’t have high expectations of. You’re not allowed to choose all the best people and every hospital is meant to employ applicants from each group, however not all hospitals stick to the rules. Also, hospitals sometimes have applicants they are intending to preference before the job positions are even advertised. The point is that just because you miss out on a certain position doesn’t mean to say you’re a terrible candidate. Often it’s not your fault and are other factors at play.
The trick is, keep trying. Try again next year.
As you progress through your career you’ll make a great impression on a number of your bosses. As an example, I met a senior resident who really impressed me when I was doing a locum position up in Lismore Base Hospital. She wanted to specialise in intensive care. I’m fairly well known and connected in that world, so I told her “If you want an intensive care position, use me as a referee.” I actually volunteered myself to be their referee. This particular person has now got an intensive care trainee position at a major teaching hospital next year. I not only wrote the reference for her, but I also rang the Director of Intensive Care at this hospital and told them, “This person is really good and you’d be insane not to give them the job.”
There are people around like me who will go to that extent in supporting the young doctors that impress us. We certainly remember what it was like when we were young and looking for jobs. If you are an outstanding candidate, we will volunteer to be the referee. If someone ever tells you to use them as a referee or you are working with someone that you know is quite influential, ask them very early (while you’re working them but not when they’re busy with their duties), “I’d like to do X. Will you be a referee for me.” It’s a very useful way to advance your career, assuming of course that you get on with the person and you’re a worthwhile candidate that the referee is
The top people are not the people with the highest marks. The top people are the ones that worked the hardest, the ones that always gave a little bit extra and stuck around to finish their cases rather than go home just because their shift is done.
You’d be surprised at how many of the millennial young doctors leave right at the end of their shift. We (the senior doctors) are not particularly impressed with that. What we are impressed with are people who apply themselves and are interested in finishing a job that they started.
Personally, if I am in theatre and they come and ask me if I could come do an extra case because of an acutely unwell patient, I will always say yes unless I have got a good reason not to. In providing that extra service beyond your regular duties, the people you work with come to respect you more. It’s a very flattering thing when the other doctors and the hospital staff ask you to look after them when they are undergoing operations.
I remember when I was just starting out, there was a senior anaesthetist I was working with who would get asked by all the staff to anaesthetise their parents and themselves. I was really jealous and I thought to myself that I wanted to be like him when I’m established. I want to be the go-to guy where the hospital staff come and want me to look after them. I achieved that.
All the time you see junior staff doing things that could be done a lot better. Basic things such as the correct way to hold a laryngoscope. When you pick them up on it, a lot of junior staff argue with you and think they know better. The fact is that they’re just making life difficult for themselves.
1️⃣ Being resilient
2️⃣ Be a bit more empathetic than me with people
3️⃣ Identify your goals and work to achieve them
To add an extra one, 4️⃣ Be a nice person. When I talk to a patient I don’t talk as a doctor to the patient, but I actually try and talk to them person-to-person and as an equal. Talk to your patients, find out a bit about what they do and understand the people you’re dealing with. Every patient is different.
Everyone is the same, so try and understand the people you’re dealing with. Go through the motion of identifying what their issues are and on an equal basis, rather than from the high ground as the doctor. Patients react to that very well and they will tell you things if you talk to them as an equal that they wouldn’t tell you otherwise if you talked to them as if you were a higher species as a specialist doctor.
It’s always very useful to be a patient yourself occasionally. In the last few years I’ve had my gallbladder out and a few knee arthroscopies. You realise as a patient on the other end, that the only minor operation is any operation you’re not having yourself. The other thing is that no matter how much you know about medicine, as a patient you’re put in a hostile uncontrolled situation. No matter how clever you are, you have no control over the situation you are in.
One of the things that I’m teaching everyone these days is the importance of communication to patients when there is a delay. Often we send for patients and then everyone decides immediately afterwards, let’s have a cup of tea. So the patient is stuck in the anaesthetic bay.
All you need to do is go up to them and say, “Can I get you a magazine? I’ve asked the staff to have a quick cup of tea because they’ve been working really hard this morning. Is that alright? We’ll be 20 minutes. Is there anything we can do for you while you’re waiting?” I’ll apologise to the patient for the delay, and they are universally grateful for that communication whereas most of the time people just leave them in the anaesthetic prep room. So they’ll be sitting in the anaesthetic room listening to every sound and imagining that people will come in and attack them with a large needle at any second.
Communicating that the staff is having a short break, while it may seem like a little thing to you or I, is very important to the patient. It’s the little things that are important in life.
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