RCSWA Albany Medical Coordinator and GP Dr Christine Oosterhuis has been an intrepid traveller in body and mind her entire career. In this wellbeing feature, she delves deep into her professional life and shares her unique approaches to self-care...
Q. What has been your career pathway to date?
My career pathway through Medicine has been varied, challenging at times and certainly NEVER boring. I studied medicine at UWA, going straight from high school and right through six years without stopping - graduating in 2001. I did my first two post-grad years at Fremantle Hospital which I thoroughly enjoyed; the friendly and approachable senior medical staff, the Blue Room and the hospital's proximity to the Freo cappuccino strip were highlights.
This was followed by a six-month placement at Princess Margaret Hospital for Children, and then a 12-month work placement in Galway, Ireland working as a registrar in Accident and Emergency. I took the opportunity to travel Europe, USA and South America for several months including a three-month stint as a Medic/Youth Leader on a Raleigh International Expedition in southern Chile - just the best experience!
Image: Dr Christine Oosterhuis on the Raleigh International Expedition, Aysén region of southern Chile 2008.
On returning to Perth after my adventures, I began working as a Registrar in Rockingham and Fremantle Hospital Emergency Departments (ED). At this point, now being in PGY4, I thought I’d better hurry up and choose a medical career pathway and by extension a training program. Having worked mostly in ED the previous years, I decided to sign up to the Australasian College of Emergency Medicine (ACEM) for ED training. About 18 months and two successful primary ED exams later, while studying for the next round of exams, I had an epiphany that I didn't want to be an ED consultant. This led me to much soul-searching, considering the pros and cons of other medical careers and more travel time in Central and South America.
Image: Dr Christine Oosterhuis in southern Chile 2008.
I narrowed down my preferences to Rural General Practice training, or Public Health training. I was very fortunate to secure a six-month position in the Kimberley as a Population Health RMO, mainly working in the areas of sexual health, communicable diseases and community health education, followed by a short stint working as a Clinical Research Fellow at the Vaccine Trials Group under the Telethon Institute of Child Health Research.
After 12 months completely away from ED, and by then in PGY7, I finally realised that Rural General Practice was my calling - making every single bit of undergrad and postgraduate medical training, clinical and life experience I had gained over the years, relevant to my daily work in some way.
I commenced my GP Registrar training in Albany in 2009, did a year of GP Anaesthetics training in Joondalup in 2010, then returned to Albany where I met my now-husband and ‘settled down’. Albany is definitely my happy place. For 13 years I worked in General Practice with casual hospital ED shifts before changing things up significantly, leading to my current combination of working with RCSWA as a Medical Coordinator and as a GP with special interests in a Chronic Pelvic Pain clinic. I’m also still doing occasional shifts in the local Albany ED.
Q. What have you learnt in your working life so far regarding self-care?
For me, self-care is an ongoing journey of learning, with plenty of winding roads, mountains, valleys and river crossings. When I reflect, I know that what I need now for optimal self-care is different to what I needed as an intern, or a training GP Registrar, or newly fellowed GP, or before I had kids etc. I think that as life changes, naturally your needs, priorities and your resources (eg. time!) change - so it's important to learn how to identify early when to stop and reassess what’s working and what's not.
Here are some things that work for my self-care at the moment:
1. Carving out some quiet time during the week to: listen to an audiobook, do a puzzle, do some Lego, or do my new hobby of basket weaving.
2. I find I am energised by singing and playing music in a group, so every week I attend a fun community indi-pop choir and on a different evening I play mallet percussion in a community concert band. I get so many wonderful benefits of singing in a choir - there are plenty of published articles on the neuroscience of singing, and how choirs help our brains and bodies recover from burnout.
3. I try to avoid multi-tasking on work activities - maybe it's because I am menopausal, or I have been kidding myself all these years, but I seriously can no longer multitask (except perhaps folding laundry and listening to an audiobook). Attempting multi-tasking at work is a surefire way to become less efficient, less productive, less mindful and more stressed.
4. Being part of a Balint group, which is a facilitated peer-support system for healthcare professionals. Members discuss challenging patient cases to understand the psychological aspects of the doctor-patient relationship, not for clinical advice but for personal and professional growth.
5. Having close friends who are healthcare professionals to debrief with, offload work stresses, grieve with, share funny experiences with - and most importantly for me - to LAUGH with!! Nothing gives me a big hit of dopamine, oxytocin and endorphins like a great big belly laugh.
6. Having my own GP to care for me holistically, which reduces the cognitive and emotional burden on me and takes me outside my own head.
7. Seeing a psychologist from time to time, to check-in and to learn new strategies and tools for my self-care toolbox.
Image: From left, first baby delivered as a 5th year medical student in Geraldton; travelling with friends; removing a foreign body from a kangaroo while on a John Flynn placement in Southern Cross.
Q. How are you different now from your intern self?
I don't think my intern self would recognise me now at all. I honestly feel like a completely different person now. Looking back, when I was an intern / RMO, my life was pretty easy. I just had myself to look after, my job to do and I could use my spare time for anything I liked. Of course there were some long work hours, tough night shifts and I was learning a lot of clinical medicine ‘on the job’. I even got a mortgage during PGY2 and it didn't stop me from doing anything I wanted to spend time, money and energy on.
As my post-intern life progressed, I made some choices about training/career that didn't work out for the best, and at times made me feel overwhelmed, miserable and a bit hopeless for a while. However, with the incredible support of my amazing family and friends, I was able to re-evaluate things and change my training plans (more than once!). The decisions, which at the time seemed so difficult to make, must have been the right ones for me because I immediately felt the most incredible sense of emotional relief and I never once regretted the choices I made.
Although it was certainly not the most direct pathway to becoming a GP, I don't regret for a moment the variety of medical jobs, exams and training I did prior to becoming a Rural GP, because I believe the experiences make me a better doctor and a better human being. Making mistakes, navigating challenges, growing up, getting married, having children, losing loved ones, managing my own mental health etc. has all given me life experience, which enables me to have a holistic understanding of patients beyond just their medical conditions.
Q. What advice can you offer medical students and other health professionals about avoiding burnout?
I've had what I would call ‘burnout’ twice in my working life. The thing is, I didn't recognise it early, even the second time. It wasn't until I was so physically, emotionally and psychologically exhausted I felt unable to work any longer, that I finally recognised what was going on.
I have learned some things I sincerely hope will prevent me from burning out again in the future. It's helpful for me to review and acknowledge these strategies from time to time:
1. Reflect on how you are feeling, recognise your increasing levels early and know your own key signs that indicate you are feeling stressed, run-down, or finding it difficult to cope. For me, some key markers are when I frequently dread going to work for no particular reason; when I frequently become touchy, short-tempered or even angry both at work and home; when my verbal and written communication with colleagues becomes more brief, terse, possibly even mildly hostile; and when I experience a profound sense of reduced professional competence.
2. Set firm boundaries where possible. Say no to extra work and be clear as to what you are taking on. Know your limits. Learning these skills can be important in protecting your valuable time, both in and out of the workplace. I put in the caveat of ‘where possible’ because it's clear that rural/regional practitioners are routinely confronted with professional boundary issues in everyday situations, far more so than in an urban setting. Acknowledging and accepting the nuances of dual relationships and boundary setting in different clinical learning contexts are vital and individualisation of boundary setting is key.
3. Since I know that I struggle with maintaining the aforementioned boundaries, I have a trusted group of peers, mentors and advisors (not necessarily close friends) who I refer to as ‘My Personal Board of Directors’ (PBOD). When I need them, they provide honest feedback, advice and strategic guidance to help me navigate both my personal and professional lives. Sometimes I need them less than other times, but they have helped to serve as a sounding board for important decisions and challenges and they have many times saved me from myself (like making a poor decision about a job offer, that in hindsight seems obvious but didn't at the time).
4. Seeking out and maintaining a solid, supportive and collegiate workplace - if work is a significant part of your life, then workplace culture can have a profound impact on your individual wellbeing, feeling of value and productivity. I am pleased to say that I feel respected, valued and that I am an important part of the team at each of my three workplaces - in ED, GP and medical education. There have been some ups and downs, but feeling appreciated and acknowledged makes me look forward to attending work each day.
5. Take control over the things you can change and focus on things that will make a difference. Small changes can be transformative. I can honestly say my life as a GP has improved immensely since I started using an AI medical transcription program to assist in writing my consultation notes, letters, etc. The system reduces the time I spend on administrative tasks, enabling me to spend more time on direct patient care, which is my passion. You might be able to reduce your clinic times, or space your consultations times more to your advantage. After a few years of ‘trial and error’ I currently have a balance between clinical and non-clinical work that suits me and my family. I work 0.4FTE Medical Education (RCSWA - Albany), one day per week as a GP in a Chronic Pelvic Pain clinic (a complex, challenging, and highly rewarding area of medicine) and occasional shifts in ED.
Watch an early career interview with Christine here
