Awakening Doctor
The Awakening Doctor podcast explores the personal stories of those who work in the medical and health professions. Each episode aims to highlight the humanity of an individual doctor or healer, and thereby challenge and transform social perceptions of the profession and the individuals who practice it. Join Dr. Maria Christodoulou as she meets with colleagues, leaders, and educators in healthcare to reveal the human side of being a medical professional.
Awakening Doctor
Dr Angela de Sá, Reclaiming the Humanity in Healthcare
What are the deeper reasons that draw us into the healing professions, and how do they shape the way we practice medicine?
In this episode of Awakening Doctor, Dr Angela de Sá – family physician, integral coach, and senior lecturer at UCT's Department of Family, Community, and Emergency Care – reflects on the experiences that have shaped and defined her medical career. From childhood illness and loss, to leading a busy community health centre for 16 years, and the recent pivotal decision to step away from clinical practice in search of greater balance in her life.
Angela speaks candidly about the work ethic instilled by her immigrant parents, the role coaching played in opening up new ways of listening, leading, and relating, and the surprising difficulty of letting go of a long-standing role to embrace a new chapter.
We explore themes of identity, resilience, and the unspoken costs of a profession that too often prioritises self-sacrifice over self-care. We also reflect on the complex relationship between creativity, perfectionism and self-worth, and the idea that tending to the 'human’ in healthcare is a pathway to transforming the practice of medicine.
Whether you’re a medical professional, a patient navigating the health system, or simply contemplating change, this episode offers a compassionate, thought-provoking look at what becomes possible when humanity is at the heart of healthcare.
If you enjoy these conversations and would like to support this work, please consider donating to our podcast fund using the link above. Your contribution helps us cover production costs and keep bringing you great content. No amount is too small and your support means the world to us. Thank you for listening!
Host:
Dr Maria Christodoulou
Follow us on Social Media:
Instagram: https://www.instagram.com/awakeningdoctor/
Facebook: https://www.facebook.com/AwakeningDoctor
Website: https://www.awakeningdoctor.com/podcast
Disclaimer: The views and experiences shared are those of the individual guest and do not necessarily reflect those of the host or the Awakening Doctor podcast. All accounts are personal and have not been independently verified. No responsibility is assumed for the accuracy or completeness of the information shared.
But what I would like to bring to medicine is a different perspective, a different way of being a clinician, being a healer, and by that I mean drawing in a lot more of our humanity. I think in doing that, we can almost transform the way we engage with our patients. I think it makes it so much easier to step into being somebody who empowers a patient. A s a clinician, wanting more for ourselves in terms of our lives, I want to say I'm kind of careful about that. It's not really wise of us to be expecting that when you go into a profession like this, that people almost sacrifice part of who they are. It's not wise, because many of those people start losing touch with that deep human being within them.
Dr Angela de Sá:And then the practice of medicine suffers, the patients who are at the receiving end of that kind of practice of medicine suffers.
Dr Angela de Sá:And so we, almost as a deliberately intently need to ensure that people who are going into these healing professions are actually able to look after themselves, not just others, because you have to nurture that humanity.
Dr Angela de Sá:If you don't, you end up with a corrupted form of what medicine is or healing is. I mean, I think this is part of it. We know that we can't, from a resources point of view, offer this current medical model to everyone. So if we come at it from the belief that we always have to fix it and make it right and we take away the power to do that from the community, we'll never get it right. The way we come at it from has got to be like the community has got to take this responsibility. And then, yes, of course we are the experts, we can give the advice and the whatever, but the healthy habits have to be installed by the community and that you can't fix 20 years down the line when the person is diabetic. There's got to be a lot more focus on the proactive part of it. So I think our obsession and our focus on the curative is hugely problematic and holding other role players like the food producers and all of that to account are incredibly important.
Dr Maria Christodoulou:Welcome. I'm Dr Maria Christodoulou, and this is the Awakening Doctor podcast, a space where we discover the personal stories of those who work in the medical and health professions. Join me as I explore the hopes, the fears, the aspirations and the real-life challenges of those who carry the title, responsibility and privilege of being a doctor.
Dr Maria Christodoulou:Joining me today is Dr Angela de Sa, family physician, integral coach and senior lecturer at UCT's Department of Family, Community and Emergency Care. Welcome, Angela, it's lovely to have you with us today. Thanks, Maria, great to be here with you again. Also with us is Amy Kaye, the producer and editor of Awakening Doctor. Hi, Amy.
Amy Kaye:Lovely to be here, as always.
Dr Maria Christodoulou:So, Angela, the question that I think some of my guests are getting a bit bored with, but which feels like a good place to start, because I like for you to define the entry into your own story, where should we begin? Where would you like us to start telling your story?
Dr Angela de Sá:Sure, you know, the one thing I always ask my students when we meet for the first time is why they did medicine and how the course, because these are final years, how the course has fundamentally shaped them in those six years, and I think that's actually quite important. What was the hook that gets us into our careers? And it's so unfair at the age of 16, 17 to ask people to make that decision. But consistently and I resonate with this every single time, consistently what comes out is I want to help people, we want to fix the world, we want to fix the injustices that are out there.
Dr Angela de Sá:I resonate with that, even though if you asked me that question 15 years ago, it would have been slightly different my response. I just wasn't that aware of it. Maybe I should sort of explain that a little bit, but I think it's in the how we want to help. Why do we get into medicine? Why do we get into these healing professions? It's not just doctors, it's nurses, it's all of those of us in the healing professions. I think we have to own what sort of drives us into that space and what is it that we need out of that space for us to truly, truly then be able to manage ourselves appropriately in w hat is a very difficult profession, I think that for me, is without that self-awareness, without knowing why we go into these careers, we almost perpetuate the stuck record.
Dr Maria Christodoulou:And I hear you I mean, that is the most common answer that students have given me too for why they get into medicine, and you're talking about final year students saying that's what motivates them. What do you think it is that, for you at 16 or 17, made you want to help in a way that made you sign up for medical school? What had you seen, witnessed or experienced?
Dr Angela de Sá:I had an older sister who had epilepsy. She had a significant brain injury as a result of a severe pneumonia at a very young age and developed secondary epilepsy to that and then she passed away when I was five, six. It was quite traumatic for the family. And then I was diagnosed with epilepsy about a year or two later and started on meds. But it's amazing how we sort of hide those things, how we suppress the memories or whatever it is, because it's not something that I would have said at that young age that was driving me to do medicine.
Dr Angela de Sá:I remember at the time having a friend whose older sister was studying medicine and my parents really drove us all to find a profession. They really wanted us to go to university and get opportunities they didn't have. So it seemed like a good choice. I figured medicine was better than law, better than architecture, and it was really actually only in my fourth year that it all sort of came together for me. I had the good fortune of sitting in with a GP at the time. That really opened up my experience, that really deep connection one makes with patients, the potential for those really deep connections and how they can shift people's lives, and that's what drew me to family medicine as well.
Dr Maria Christodoulou:Right, sure, I didn't know that about your childhood and about your sister, so I'm sorry that happened to you and your family. I hear so many stories of people whose motivation for entering into medical school is something about a health challenge in the family or a health challenge in their own life. What was it like to be a medical student with that backdrop of epilepsy in your own life?
Dr Angela de Sá:Interesting. Sjoe, I didn't actually expect to be talking about the epilepsy, but ja, I actually, interestingly enough. I mean I was diagnosed with the epilepsy and then at about the age of 12, took myself off the meds because I'd never had a seizure. So I think at the time when the diagnosis was made it was obviously a lot of anxiety on the part of the GP and my parents, another child with epilepsy, and obviously all of that overlay and then, because I'd never had another seizure, I took myself off the meds at about 12 or 13. Only then had another seizure when I had finished med school. In fact it was at the end of my internship year and at that stage I hadn't even thought about it for ages.
Dr Angela de Sá:It was really only after finishing medical school that I was really actually affected by the epilepsy because I had been seizure-free for so many years and had come off meds and then I started having the seizures again. So at medical school it wasn't and it's actually been a relatively minor issue in my life because I've been so well controlled. But I don't think I fully appreciated the link to my sister until a few years ago. We were doing an exercise in the coaching course and that came up and there were quite sort of powerful feelings associated with it. Really really good chance I was suppressing a lot of that all along.
Dr Maria Christodoulou:Which ties into your comment earlier about how often we enter medical school with this underlying hidden perhaps even from ourselves motivation to help or to heal or to fix something that we felt powerless to fix or to heal. I remember we were guided through a visualization where we had to take ourselves back to our first experience of illness and to connect with what we were feeling at that time, who it was happening, to, what we saw happening around us, and I remember that for me it was a time of, I think my brother and I had both just got measles and we happened to be on holiday in Cyprus with my grandparents in a small rural village and my mother was with us. My father was still here in South Africa.
Dr Maria Christodoulou:He was going to join us later and so we didn't really have access to a hospital or to doctors or in that setting, and there was a lot of village wisdom about how to deal with kids who have measles. But my mother was completely panicked. She was really anxious about the fact that we were ill, worried that something serious was going to happen to us. My memory was of being in the small dark room and feeling the panic of the adults in the space around me and almost like making an unconscious internal vow that I wanted to be able to fix that. I wanted to be able to address that feeling of helplessness that people had in the face of illness, in the face of vulnerability. Unconsciously, one of the many reasons why I ended up in medical school was that wish to avoid those feelings and to help other people not have those feelings of p owerlessness, of helplessness in the face of illness, and almost this unconscious idea that if we know about illness we'll be able to fix all of those things, so people won't have to feel that way.
Dr Angela de Sá:Sjoe. Brought back such powerful memories. T imes when my sister used to have her seizures. More often than not they would have to get the GP out to abort the seizures and, yes, that very strong sense of angst on the part of my parents and being very aware of that, and then, obviously, you know, being told that evening after she had died because she had gone into status. It was a rough time for them, rough time for us.
Dr Maria Christodoulou:I'm sure. Tell us a little bit more about your family. I know your parents were immigrants, right?
Dr Angela de Sá:Ja, from Madeira, Portugal. I always have a really soft spot for immigrants I really do when I see them as patients in my clinic, because I know it's a rough ride. It really is. My dad was 16 when he came out to South Africa and started working, and then my mom was 19 when she came out to South Africa and didn't speak the language. My father, as I said, started working straight away and then the key message, growing up as a child of two immigrants, was work hard. I remember that being a key message for us and it was as long as you work hard, you'll get somewhere in life.
Dr Angela de Sá:The sense of community my parents had a group of Portuguese friends. The sort of sense of identity that it gives you is great, it really is. B ut at the same time, there's also that sense of an otherness, not being part of. But on the whole, I'm quite grateful for it. I think that sense of identity, of heritage, of background, is something that I've really tried to pass down to my kids as well, and it's the beautiful diversity, the link between their South African heritage and their Portuguese heritage and just the fact that they can just so seamlessly float between these spaces. I speak the language, all very positive experience.
Dr Maria Christodoulou:Right. I see that with my own daughter too. But at the same time, that thing of I can't remember the words you used now, but I remember growing up, that feeling of like I didn't quite belong here but I didn't quite belong there. My family was from Cyprus, but I was born and growing up in South Africa, and so I've spoken about this before, in the one country I was the Afrikana, and in the other I was the Griek, and for me that was like a tension that I couldn't, I struggled, to resolve in myself.
Dr Angela de Sá:Nobody gave me a hard time because of my Portuguese identity, if you want to put it that way. I don't think anyone gets through school without being bullied. It wasn't because of my Portuguese identity. I think it's also who we are, our personality. Some of us are more aware of feeling more of an outsider than others, and I guess that that just sort of accentuated it rather than that it was an active reason for it.
Dr Maria Christodoulou:Right. So, on that backdrop of being a child of immigrant parents who taught you to work really hard, the experience with your sister and her epilepsy and everything that that involved, you make a decision to go to medical school. What was that like? How did your family feel about you going to medical school?
Dr Angela de Sá:I actually remember not having gotten accepted initially, and my father then going with me to medical school and us going off to the dean's office and I'm not quite sure who we spoke to. I was 17 and he just wanted to know what was happening. And then, about a week before varsity was starting, I got a letter of acceptance. Obviously, everyone had decided where they were going and then there were gaps that they could fill. He was always someone who was working hard in the background. You know, my mother was the one who was always looking after us, but the fact that he took that time out went with me to medical school, I mean, that was huge. You know, that was like let's go find out what's happening here, because that is a kind of like a journey that I had negotiated by myself, with their support obviously, but just the application process and all of that. It was just lovely to have that kind of support and enthusiasm from their side.
Dr Angela de Sá:And so obviously quite a bit of pressure to perform, given that it was so important for the family. It got quite rough in third year. I really did not enjoy my third year too much. That was the one year I almost failed. Thank heavens for supplementary exams. I just did not enjoy third year. The subject choices were just terrible. I think it was pathology and microbiology.
Dr Maria Christodoulou:You went to UCT right? Ja, I was at Stellenbosch. I'm sure the curriculum was pretty similar. But I also remember third year is the year we did our first sort of clinical exposure and witnessed babies being born and things like that.
Dr Angela de Sá:No, no, that only happened to us in fourth year. That's when I really started to enjoy medicine. It was the contact with people and the clinical years. I must say I really enjoyed my internship. We didn't do Comm Serv those years so many years ago. It was just the internship and then your senior house officer rotations and then I went into my family medicine training quite early on. At that stage we were doing sort of a vocational training program rather than the MMed that they do now.
Dr Maria Christodoulou:But you were kind of one of the early cohort of people who chose family medicine as a discipline. What was it about family medicine for you that was compelling?
Dr Angela de Sá:Well, it was really the connection with people. I was very interested in psychiatry as well and I put in my application to psychs as well. And then I remember getting calls, w as I still interested, b ecause there were posts opening up? And then I just decided I'd been working in the day hospitals for a while and I just couldn't see myself doing psych. I had really connected with the work that I was doing in the day hospitals and really connected with the people.
Dr Angela de Sá:And I'd obviously done family medicine, I'd already completed that vocational training. That's why I stuck with that, you know, rather than going with psychiatry. And it was the relationships I just so enjoyed my 13 years at Heideveld. Over those 13 years I made such really significant connections with patients, got to know them really well, their stories. I'm still thinking now of this mother and daughter pair that would come and see me. So it was quite interesting. The daughter was mentally ill, mom was obviously still looking after her, but it was like a comically conflicted relationship between the two of them. But they just add such richness to your day when you know that it's this patient with her daughter coming to see you today. And I always say to the students you're not just seeing someone who has diabetes, Mrs A or Mr B, and you're helping them with their illness. To just keep that in mind always. That's what makes it worthwhile, the people that you're connecting with.
Dr Maria Christodoulou:Right, and you've spent gosh more than 30 years working in the public sector right?
Dr Angela de Sá:Yeah, I've sort of moved around a little bit. Heiderveld, and then I worked a little bit at D. P. Marais and private practice, and then Retreat is where I was stationed for about 16 years and that's where we met.
Dr Maria Christodoulou:Yes, I was just thinking about that. That was where your interest in coaching was sparked.
Dr Angela de Sá:I was actually talking to somebody else today, just so that you know who said you had also inspired them to get into coaching. It really was you and my interaction with you as part of that research program that sort of inspired me to get into coaching. The piece of the puzzle that made sense, the work I was trying to do at retreat, the work I was trying to do as a family physician, in terms of trying to improve the services just always felt...
Dr Angela de Sá:I mean, there were so many projects I'd gotten involved with and it was just, always felt like we just weren't connecting with the people. And that that was always the bit that seemed to fall apart. I remember a project that we got involved with to try and improve the flow in the facility. It seems like the full 16 years I was there was all about just trying to improve the flow. It was MBA students who were visiting from MIT. They were coming out. So this was the second cohort of students that had come out. Right. They were employing things like lean management techniques and we were going to fix the pharmacy flow. We were going to sort that out.
Dr Angela de Sá:Oh, that failed dismally. We just didn't consider the people. We really didn't sit down and think that through. I remember feeling at the time like looking at it in retrospect and thinking how on earth did I think this was going to actually fly, given you can always obviously look at it in retrospect and see how it kind of fell apart. And there were a few other projects I'd gotten involved with. All of these wonderful projects, too little time paid to really sort of give people the space to talk, space to really hear other people's thoughts, contributions, w hat they thought might help, might not help. I remember something you said that really stuck for me during one of our sessions was the conversations are about 90% of the work. You can have those conversations and they are meaningful conversations and people get given the space to talk, the implementation just flies, and it's certainly something that since then, I've tried to practice.
Dr Maria Christodoulou:Maybe for context for our listeners who don't know, Retreat is a community health centre. Maybe you want to tell us a little bit more about what exactly that community center did and you know what happens for patients. What is the role of the family physician in a centre like that?
Dr Angela de Sá:As a health facility. I feel the need to say that the people I work with have tremendous heart and they are willing to really go the extra mile for the patients, for the community. They really do. I think that's very important to keep that in mind, because we know that there are certain things that almost set us up for failure in some instances. So I think it's obviously a primary health care centre. We provide services where we're looking after your sort of GP type of cases. We do have a 24-hour emergency centre where we see people with emergencies. We have a labour ward where ladies give birth to healthy babies. It's a very busy clinic. We will usually see anything between three and three and a half thousand people through our emergency unit per month, so that's quite a big number. And then in our day-to-day running of the clinic, anything between 400, 450 people coming through the door Monday to Friday, daily needing some help.
Dr Maria Christodoulou:How many doctors versus nurses do you know?
Dr Angela de Sá:Got about 10 doctors. Those are doctors that are working there regularly. A lot of them are senior permanent doctors, and then we've got some part-time doctors, so they're not all full-time, part-time. And then some junior doctors who rotate through the facilities on a rotational basis, and then we've got five clinical nurse practitioners as well.
Dr Maria Christodoulou:Am I correct in saying that as the family physician, you sort of oversaw that entire medical team and the services offered by the facility?
Dr Angela de Sá:Yes, so I had a joint role with UCT and the Department of Health. I had a clinical role and a clinical governance oversight managerial role on the Department of Health side, but with UCT I was responsible for clinical oversight of final year medical students and registrars and then teaching and doing a bit of research as well.
Dr Maria Christodoulou:And I guess what's interesting for me about the time when we met right, you might recall, it was actually a province-wide leadership survey that was done in all the facilities and looking at the culture of the Department of Health and looking at in different facilities in the province kind of what were the gaps between the espoused cultural values and the actual values of people in the system.
Dr Maria Christodoulou:There were huge gaps everywhere and all the different facilities were offered this opportunity to have some support and input with coaching and with some group process to work towards closing those gaps. Yours was the only facility that took up that offer, from about 12, I think it was maybe more facilities at the time that participated in the survey. So I was curious even back then about what it said about you and your team, because there was a senior management team of three people, if I remember correctly. What do you think it was about your team and about you? Because you and I are the ones sitting here today and you then ran with the coaching and studied coaching and now offer coaching yourself. What do you think it was that opened you up to being receptive to this process?
Dr Angela de Sá:I think a lot of it was that sense of we've done a lot of these projects, and I remember having a conversation with a colleague around about the same time saying, we keep doing these projects but we never really are thinking about the people involved. So we can have all of these wonderful ways in which we approach it, but unless we look at the human beings behind all of these interventions we're never going to. And that's why the Barrett survey made such complete sense to me and I found that over and over again, and then my facility manager at the time and the one operational manager that you worked with, all three of us, they were quite willing and keen. I think you will find in most facilities people would be quite willing and keen if they understood the purpose.
Dr Angela de Sá:So I don't know how much of a conversation was had with the others, but I was kind of looking for something like this and I think for me it was a gift and I do firmly believe that. Keep your eyes open, because the universe has this way of bringing you these gifts which you need to take.
Dr Maria Christodoulou:What I also remember about that time when you and I were having those conversations, that, although the focus was on how to improve the system and how to close that gap in terms of the cultural values and take better care of the people, what emerged was just how burnt out you were and the toll that working in that environment was having on you.
Dr Angela de Sá:As you say that I'm almost thinking, oh gee, was I really all that burnt out? It's interesting, you know how much we can hide from ourselves. Really. Put that jacket on and we just keep going. What I want to say is and I think it's important that just that message of ignoring our own needs is something that I do want to touch on. That's so important, and it's something you reminded me of 10 years later when we were having a conversation a few years ago of this, because, as you know, my recent journey has been to shift out of my post at Retreat and I've now shifted into something else which I'm really enjoying.
Dr Angela de Sá:We can kid ourselves, we can go on for years in a very stressful job that really can take quite a bit out of you and leave less and less of you for your family, for others, for your partner, your friends, for yourself. Actually, that's the important thing. And so, even though there were parts of the job that I absolutely loved, and I really enjoyed connecting with patients and I really enjoyed connecting with the students, which I'm still doing, I really love, and with my colleagues, I'd made it so difficult to leave that job.
Dr Angela de Sá:I had such a wonderful team that I was working with at Retreat as well.
Dr Angela de Sá:But at some stage one has to say you know, like what is it that really enthuses you? Where's your passion now? And it's not to say that medicine was never my passion, don't get me wrong. It clearly was and still is. But the direction I find myself being pulled in now is more one of how can I be of support to my colleagues, because I realize that it is a very difficult profession to navigate.
Dr Angela de Sá:I see young students and I see young doctors really struggling in this profession. And we're not talking just about the odd person, we're talking about a significant number of people. And the big question really is why are we not being a lot more proactive at helping ourselves and helping each other? What is the block? Because it seems like a relatively straightforward thing to do. It just makes complete sense to me that as part of your training, as part of your undergrad training, if you know that this job demands so much of you psychologically, emotionally, physically, we should be better preparing people from that undergrad level.
Dr Angela de Sá:We talk about resilience, but what do we really mean by resilience? What kind of skills do we really need to imbue these young doctors with? Just not offering it and that self-awareness, that sense of self-awareness and understanding what motivates, what drives us, how we are in the world, how we show up in the world. A ll of that is something that we really should be cultivating and integrating into our learning at undergrad level all the way through to postgrad and beyond, o bviously. I think of the leader I was when I started in my job at Retreat and I would have done things so much more differently if I'd had the insight I have now. I would have done so many things differently.
Dr Maria Christodoulou:Can you give an example of something you might have done differently.
Dr Angela de Sá:I think a lot of it is just around my self-awareness. Coming to the world with a certain story about others, about the world, about who we are, and we really want to protect our little bit of Angela, our little bit of Maria.
Dr Angela de Sá:So those little defense mechanisms can really trip us up, and I see it time and time again. It's actually quite amazing how common that sense of being an imposter is amongst these highly qualified, highly capable group of people, and so if there was less of an angst about that, more of a realization that we're all in the same boat with these anxieties we have about how we show up. W hat I'm really just trying to say is, we're so busy protecting our egos isn't it, that we forget that we're actually all just human beings. Each of us has something of value that we can bring to the table and that we just need to be deeply appreciative of what each of us brings to the table, and as soon as we can do that, it just opens things up. It's amazing how, when you just take the position that everyone comes to work to do a good job, if somebody's not doing a good job at work, then what is it in their environment that is not allowing that to happen?
Dr Maria Christodoulou:Right.
Dr Angela de Sá:And so actually my job as a leader would be to try as much as possible to create the environment that is conducive to the very best that is within that person come out, right? That's the shift I would have made much earlier, as opposed to being very critical and I know I can be quite a critical person. I know people have given me that feedback. I just want to say you must just know what it feels like on my side. That coming at you is a lot less than it's coming at me. It's that humanity and being a lot more comfortable, accepting of myself, obviously, and in that being a lot more accepting of others. That's probably one of the key leadership traits I like to leave others with. Know yourself, you have to understand yourself a little bit and you know, that immigrant work ethic, I mean, that's what got me through it all. Medical school, those after hours, that constant grind. It's tough. You have to have the work ethic.
Dr Maria Christodoulou:And it's inculcated into us in medical school and it's almost like a badge of honour to work in that way and like a rite of passage and there's almost a sense of you're more of an imposter if you can't subscribe to that work ethic and if you're not willing to put up with the long hours and the excessive demands and all of that. And I do think there's a younger generation of doctors that is beginning to challenge that in all sorts of ways. Part of me, the academic voice in my head, goes we've been talking about these things for years and years and years and academics with heart and depth and wisdom and vision have been looking at our curriculums and looking at how they can change this and adding all sorts of things in and taking away other things. And you know, we talk about zero tolerance for bullying and we talk about emotional intelligence and we have started including coaching and mentoring in our curricula. And then I mean this very week I don't know if you heard about the intern who dropped dead in a hospital and you spoke earlier about knowing.
Dr Maria Christodoulou:You know, what is it that makes us use the word neglect? I don't remember the word. What is it that happens that a bright, intelligent, highly educated young man ignores his own inner experience of illness to the point where he drops dead on a hospital floor because a consultant demands that he be at work. I mean, it's horrifying, it's unimaginable, it's unthinkable that this happens, and I've been watching the flurry of messages on LinkedIn and all the sort of people advocating for systemic change.
Dr Maria Christodoulou:Part of me wants to go. What is it? What happens inside somebody that, when they are that unwell, they bow down to that pressure to go and be on the hospital floor? What is it that makes us drag ourselves through a workday when we are exhausted, burnt out, drawing on drugs and alcohol and dysfunctional coping mechanisms? You know. So we can talk about resilience and cultivating resilience, and we can talk about individual egos, and you know the fragility of our egos and I will attest to that in terms of the imposter syndrome. But there's something for me in the hidden curriculum in the we want you to be a change agent, but you dare speak up against the system. Before we started this conversation, you said what you just shared now about how you don't want to come across as too critical of yourself and of your colleagues. What is it that makes us hesitate to criticize the system?
Dr Angela de Sá:So I'm going to say the system is us. Yeah, we are that system. And you know, the thing is, I think what trips us up starts much earlier than medical school. We are shaped obviously by our genetics, our nurture, and I think certain people are drawn into the healing professions and there's the common refrain of wanting to help others, be that change agent to fix things. But I think, if we were to be honest with ourselves, there isn't always an altruistic, a purely altruistic intent.
Dr Angela de Sá:That there is obviously something we need back out of this career.
Dr Maria Christodoulou:Right.
Dr Angela de Sá:I think it trips us up quite a bit in terms of our relationships with our patients as well and how we can support patients in their own sort of health journeys. And I mean maybe to be a little bit more explicit about what I mean. But if I'm coming at my patient with the intent to fix you, or I'm going to help you in the way that I think you should be helped, if I'm not aware of what it is that I need out of this consultation, which is your adherence and the improvement in your health status, because otherwise I feel like I haven't done a good enough job, because your health is very dependent on what I give. Right, If I have to be honest with myself, if I'm expecting that from my patient, if I'm expecting their health and their adherence to that, am I really actually empowering that patient to be looking after themselves? Am I really being the person who walks alongside and guides and advises? Am I being the person who's actually disempowering and taking away from the patient their agency?
Dr Angela de Sá:It's not to say that we all do this, but I mean I remember myself in my younger days I had a colleague who would often comment on how intimidating I was towards patients, and it's crazy. We've seen those kinds of consultations. So to come back to the question about what it is that makes us so hesitant to criticize actually, I hear people criticize a lot. People do criticize a lot. I do.
Dr Angela de Sá:I hear it all the time, but it's someone else in that system that is responsible, and I think until we can get to the point where we take ownership of what it is within us that drives us, we're never going to really change that system. So it really is about turning focus on us and our inner drivers and what it is about us that makes us ignore our own needs. And to give you an example, I'll say to the interns you must take lunch, take a break, don't feel guilty about needing to go to the toilet. Not that I'm giving them a hard time, and they still struggle to take a break for lunch when they're hungry and to go to the toilet when they need to. That's not the patient or me. We have to ask what's going on within us, what's driving us?
Dr Maria Christodoulou:And I think, as you know, with most things, some of that is individual and unique to the person, but some of that is also the system and you know we throw out this word the God complex.
Dr Maria Christodoulou:If you are elevated to the status of God, you don't need bathroom breaks and lunch breaks.
Dr Maria Christodoulou:But then there's also the thing of I remember having this conversation many times with doctors who were working in very busy facilities where they feel bad to step out and go to the loo or take a lunch break when there's a waiting room full of people and so they slink out like guiltily to make their way to the bathroom and then the patients get into an uproar because the doctor's like clearly wasting time when you should be seeing them or she should be seeing them, as opposed to stepping out of the consultation room and going.
Dr Maria Christodoulou:Sure, guys, I know there's 50 of you waiting and we getting close to the end of the day. I need a quick five minute bathroom break and I'll be back. There's something almost like we aren't human, so we can't admit that we need a quick break or that we need to go to the bathroom for a few minutes, that we are aware that 50 of you are waiting for my attention and we keep our heads down in the consultation room, patient in, patient out, patient in, patient out, and then we earn a badge of honor for the number of patients that we see, but not for the kind of interaction we had with those patients.
Dr Angela de Sá:Quite sad, very sad. I can kind of say to the students take your pile of folders, go out there not to the students, the interns and just read out their names. Now, patient A knows they're behind patient B.
Dr Angela de Sá:And then you're going to take a lunch break between patient D and it's great and they're amazing. The patients are amazing about that because of course you need a lunch break. I think it is so important. You're right. Go back to my coach training. Oh, it's amazing the sort of humbling experiences you have as a result of those things.
Dr Angela de Sá:But I remember that whole, my metaphor stepping up on a bit of a pedestal and that heavy cloak of responsibility that one wears and suddenly realizing the person who's put myself up on that pedestal aren't other people, it's me, and the heavy cloak of responsibility is not mine to carry, it's other people's and I walk alongside and I think that's a big part of it. We really do need to be challenging that, b ut from a much younger age. T he concern for me is the disservice we potentially do to our patients. Actually, when we come at medicine with that going on in the background and I often say this to the students as well you know your gold standard for patient A is not necessarily the same gold standard for patient B. It's so important to be able to follow the patient and meet them where they're at, what they're ready for. Otherwise we're just going to constantly set them up for failing in their care. To have that truly concordant sort of like relationship and have those kind of consultations with patients requires us to sometimes follow our patients.
Dr Maria Christodoulou:And let go our agenda of where they should be and what they should do.
Dr Angela de Sá:Absolutely yeah, because what does it mean about our ability to do our job if they're not quite where we would like them to be at?
Dr Maria Christodoulou:You said earlier that coaching had given you the missing piece. What was the missing piece, if you can put it into words?
Dr Angela de Sá:Ja, I think a big part of it was my self-awareness and realizing how I was tripping myself up. Look, I think as family physicians we tend to pride ourselves. W e meet the patient where they're at. But I don't think that I really ever truly understood the concept of generative listening until I'd done this coaching course and really understood how important it was to sort of respect that patient's ability to really come up with their own sort of solutions of their life problems. And look, I mean, obviously, if you're talking about a patient with an appendicitis, it's straightforward. But when you're working in primary care especially, and you're working with chronic diseases and patients with chronic diseases all the time, you're only there for a fraction of the time with them.
Dr Angela de Sá:And the rest of the time, they're the ones who've got to be their own agents and look after themselves. So one of the beautiful examples I always use with students is with brief motivational interviewing, because I love that it's got such a lovely sort of opportunity to bring in all of those coaching techniques. Just the way we have the conversations with patients was the self-awareness and also, just in that self-awareness, being much more aware of the relational space and how what I was doing was impacting the way the patient was responding, and not just looking at what the patient was saying and just looking at the patient, looking at both of us in relating to each other, but also looking at my issues and my baggage I was bringing into it.
Dr Angela de Sá:That was the same with leading a team, engaging with your colleagues, with everything.
Dr Maria Christodoulou:Right. So we've touched on coaching as a turning point in your career and kind of how that opened up things and added this piece that you've now brought to this next stage of your working life. What are some of the other times in your life you look back on and think of as pivotal turning points or significant milestones, what things stand out?
Dr Angela de Sá:Certainly having my two children. Amazing what kids teach you. He's now 15 and she's 13. Interestingly, actually it wasn't intended to be that way, but it happened quite soon after I started my job at Retreat that I had him. I do think it's quite crazy that in the time that we are so taken up with that parental role, it's pretty much almost the same time that we get so taken up by our jobs and our careers. Look, I understand the reality of the situation and what we're in.
Dr Angela de Sá:So don't get me wrong, but I think as a humanity we have to sort of ask ourselves you know, do we have our ducks in a row here? That there are these incredibly important beings in our lives that we really are needing to nurture and look after and connect with, and all of that. It was one of the things that really made me decide to shift out of my job at R etreat, was just the sheer pressure and the sheer squeeze. It just left nothing almost for the kids and I didn't want to be that mother who was so focused on her career that they had hardly had any of me.
Dr Angela de Sá:And I know now, six months down the line, that this has been the absolutely right shift for me. I do joke sometimes that I feel like I'm actually working harder now than I did when I was at Retreat. There are some days that it's quite crazy, but I'm here, I am actually present, I'm a lot more here. I've had conversations with the kids that I just never had the emotional energy for when I was working full time. Very humbling.
Dr Maria Christodoulou:So I'm aware that we started by speaking about what had taken you to medical school, and then we jumped ahead to what happened in the last few years. But somewhere in the middle you met a man. You got married, you had children. Tell us about that. How did that all happen?
Dr Angela de Sá:It's actually quite interesting. I always love to tell the story about how I met my husband. I had just gotten into computers at that stage. M y word, I was just starting to get computer savvy and I went on a chat room. It was the first time I was in a chat room and he had an interesting handle. It was just a few of the things that he was saying, so obviously clearly quite naive, and we exchanged emails and we just started emailing each other because he lived out in East London at that stage.
Dr Angela de Sá:And we must have emailed each other for about a year and a half before we actually met in person. It was a slam dunk after that.
Dr Maria Christodoulou:Wow. Before Zoom and WhatsApp and Skype, and so you probably couldn't see each other.
Dr Angela de Sá:Absolutely. And I always joke with him. I say to him you know, this is only when I met your mother that I knew you were marriage material.
Dr Maria Christodoulou:What was it about his mother?
Dr Angela de Sá:It was just that solid commitment to family that really impressed me.
Dr Maria Christodoulou:Is he also in the medical field?
Dr Angela de Sá:No, no, he's a journalist and he's an editor. My mom-in-law and I get on fantastically we really do but we do have a good rib at each other. It's a great relationship. We actually went to Portugal to get married. It was lovely. We got the whole family there. We got married in the little chapel that my mother went to school. My uncle, who was a priest because he's passed on now, he's the one who actually married us, so I always joke with him. In Portugal they don't recognize the church wedding as being legal, so we had to have a legal wedding here and we got married in Portugal. That's it. He's solidly, solidly married.
Dr Maria Christodoulou:The Orthodox Church is the same. All those years ago, when I got married, we had to have a legal wedding and a church wedding. So tell me more about the decision to walk away from your job at retreat in order to be more available to your children. I know that it was not an easy decision and I know that it was a couple of years in the making, kind of getting to that point. Let's talk about the transition. What was it about that time that led you to the conclusion that you needed to leave, and what was it like to actually action that decision?
Dr Angela de Sá:I think, most demanding careers, as long as there is real passion and drive, you can kind of like almost survive the demand, the physical and emotional demands, because you're almost really enjoying it. And there were certainly aspects of my job that I really enjoyed and I would say probably the most enjoyable part was connecting with people, whether it was patients or the colleagues or whatever. But then there were aspects of the job that I had done for 16 years that I was no longer really feeling that passionate about and I wanted to try new things, coaching being one of them. So it wasn't so much about leaving medicine as wanting to do medicine slightly differently.
Dr Angela de Sá:If that makes sense and I remember thinking that as well when I left Heideveld. Y ou get to a point in your career where you feel you're not going to be able to influence or change from where you are at at the moment. So maybe it's time to move to a different position and see if you can change and influence from a slightly different position. And it's what you're saying all along. How do we make those shifts? Can we just do it from the vantage point where we're at? And look, I'm a firm believer. I have one conversation with a person.
Dr Angela de Sá:It has an impact a little bit further down the line and it does. Case in point your conversations with a few people that have set them off on coaching trajectories. I think the clear sense of needing something different, being pulled into something different, because my energy was going into that aspect and not feeling like I could find a niche where I was at, or the space, especially given the austerity coming in and the pressure on time and all of that. T hat space just wasn't there anymore.
Dr Angela de Sá:But what I found incredibly difficult and I think this is something that many doctors face when they are making these transitions is letting go of my identity as that family physician, that consultant at that hospital.
Dr Angela de Sá:And in retrospect I look at it and I think what was so difficult about that I just really don't understand, because it doesn't feel like it was something.
Dr Angela de Sá:I don't feel like I've lost anything now, if anything I've gained, but at the time it felt like I was losing something and I was losing like a really deep part of my identity. There's a beautiful talk that I listened to earlier a couple of weeks ago, and I can't remember his surname, but a beautiful talk about how important it is for us to create multiple identities, in terms of not just our work identity, and I think that's what happens to doctors. The job is so all-consuming that your identity as somebody with a hobby, your identity as a parent, your identity as all gets squeezed out because of this work identity and we become so enmeshed with it that we just can't let it go. I would say that was the most significant step I had to take. Obviously, yes, you think about finances and you think about all the other things, but we can make those things work. Identity one was the difficult one for me.
Dr Maria Christodoulou:So what would you say to somebody who is in a situation right now where they have been doing something for 10, 15 years, 16 years in your case and it's really feeling like, if they want to contribute in a meaningful way, it's not in this situation or in this role, but they're scared. This is what they know. Their identity is so deeply invested in the current role, Like what would you say now, kind of six months on the other side of making a shift in your own life?
Dr Angela de Sá:First, I'd let them know that obviously, the big shift is actually potentially in an area that you may be blind to, where the big book is for you and what's stopping you from walking away. That's the first thing, and the second thing is take your time. I mean, if you've got it, obviously for some of us, if there's a sudden hitting a brick wall in terms of burnout or something like that, sometimes we don't have that time. But to actually ideally be proactive before that, but consider sitting down with someone to work it through. I felt that helped me quite a bit. I'm just thinking of my friends on those morning walks. They must have r eally... T hey were very patient friends, always hearing about Angela's same story. Get over it, Angela.
Dr Maria Christodoulou:So what was the thing that enabled you to finally say, okay, I'm going to act on this, I'm going to make the change, because I know you grappled with it for a really long time.
Dr Angela de Sá:Yeah, I did. I think it was just realizing that in not taking that jump, which I saw as being risky, in not doing that, I was actually taking a huge risk. It's an emotional risk. It's a risk with your role with the kids and how involved you are with your own psychological well-being and all of that.
Dr Angela de Sá:And in not taking the risk, suddenly you're actually putting yourself at quite a bit of risk. Once that gelled, then it was a hop, skip and a jump, and I knew what I had to do. I just had to put things in place to make it happen.
Dr Maria Christodoulou:And maybe tell us a bit more about what you're actually doing now.
Dr Angela de Sá:I'm still teaching, so I'm really enjoying the students in a very different way. So I'm still doing some part-time teaching with the university and I've also just taken on a part-time job that has been set up in FaCE. Actually, I'm the first person that's been appointed, so it's still early days, and the research project that that's all part of, which is Healthy Futures SA. It's a multi-center research project, so University of Toronto with a few African universities, and we're really just looking at improving health outcomes in three sub-districts here in Cape Town through various interventions within health sort of ecosystems. L ooking at youth employment and entrepreneurship, all in the health space, hoping that interventions there lead to better health outcomes. So it's quite a long-term study. My job at the moment is very early days and having lots of exploratory conversations and looking to see how we can fit in that research agenda and bring things and create the synergies.
Dr Angela de Sá:The idea is really to look at where we can align, I think, the interests of the research agenda, obviously of the universities that's what the business is, the needs of the Department of Health, and I think if we can get that right, then we can really work that synergism, that relationship can really be cemented. I think it's something that I was really stuck with right in the middle, always in that joint position between the university and between the Department of Health. You constantly felt like you were being pulled in two different directions and so, actually, what you need to almost bring that together. That was quite a nice post.
Dr Angela de Sá:What I'm really quite passionate about is supporting healthcare workers and anyone who's dealing with stress and burnout. But I'm definitely much more of a proactive person, which is why I really like the coaching. I think it speaks to a very proactive how do we create the opportunity for you to really be the best version of yourself that you can be? And so what I'm doing in collaboration with a private company, is we're just running a course which is a longer-term, transformational course. It's not your quick fix to managing your stress and building your ability to just operate in what is very stressful current modern work environment. So it's that and it's a lovely mix of neuroscience and psychology and meditation and all those kind of practices bring it all together into something that is meaningful. So I've been doing it for a few years and we've done a few pilot projects with Department of Health employees. I'm loving that. I've just started my third group now.
Dr Maria Christodoulou:Wow. I can't help but think back to the conversations we had about how worried you were that nothing new would come if you chose to step away from your position at Retreat, and whether there'd be any openness or receptivity to this work that you really wanted to do. And it sounds like you've already, in quite a short period of time, put out a whole lot of new things that are aligned with this. I find myself listening to you and thinking about how there's so many things professionally that I want us to talk about.
Dr Maria Christodoulou:You have such an interesting perspective on the system and your years and years of experience in the public health setting and now in the academic setting, the work that you're doing and the coaching. And then I hear in the back of my head the part of you that said it's so common that all these other parts of who we are get squeezed out, and it almost feels like that starts happening in the conversation, like I could easily dive deeper and deeper into what the coach is up to and what the doctor is up to, and we've touched a little bit on what the mother is up to. But who else is Dr Angela de Sa? Like, w hat else makes you uniquely you?
Dr Angela de Sá:This is where we start talking about the flamenco dancing.
Dr Maria Christodoulou:Yes, I want to hear about the flamenco dancer, and I've made a note about the long-term dream that you once shared with me of being an artist on a small Greek island.
Dr Angela de Sá:I know, l'm actually looking at one of my paintings. I have parked that one for far too too long.
Dr Angela de Sá:I do remember that one and I can't say it's a dream I've completely shed, I haven't. I do want the space to just be able to potter around and do things. I'm now feeling like I'm in a coaching space, which is great. That I'm being coached, which is great. I think like, oh my word, Angela, you can stay busy and just not actually get a lot done. Just keep remembering why it is that you stepped away. So that you could find those little paths for yourself, carve out those little moments in your day that you dedicate purely to just doing things that are not work or busyness. The easel is here, the unfinished painting is there, and that's been unfinished for probably about a year or two. That's terrible. I still have the fantasy every now and again. It's not as strong as it was, though.
Dr Angela de Sá:I do think it's very important to carve out those times to just be creative and do things. What I am doing now a lot more, though, with my time is just finding opportunities to just go and be. I went and had a swim in the sea at lunchtime. I didn't get up at five in the morning like I normally do for my walk, but I had the opportunity to just quickly pop down to the beach and have a swim. It's lovely to be able to just do that. Go out with my husband for a lunch, and it's not that you're not working, you're still working. You've just created a space that gives you a little bit more ease.
Dr Angela de Sá:Look, I think that's one of the things that I was always resentful of during COVID. I was always having to go off to the hospital and everyone else got to work from home. But you can work from home and still be a very busy person. I've jumped into a lot of busyness. It's not all rosy. There's that part within me that continues to say work hard, you've got to keep going. You've got to keep working hard, because that's the only way one succeeds. I mean, don't get me wrong, that drive has certainly brought me somewhere in life. I don't know if I'm necessarily making any sense, but it's the space to think that I'm really valuing now.
Dr Angela de Sá:I'm not in a very constantly reactive space constantly. I can now sit back. I am actually enjoying what I'm doing because I have so much more space to think.
Dr Maria Christodoulou:Yeah, I find myself thinking about how crazy it is in some ways that the demands of the work environment, certainly in a busy public health setting, don't allow time and space to think, time and space to be creative, because actually what we need in the system is for people to have creative ideas and to be innovative in how they do things and to have space to pause and reflect on what they're doing. And that's what coaching often offers in those busy settings is a short period of time where all the other distractions are set aside and you think about where you are and what is happening to you. So for you to say that, having stepped away only a few short months ago, one of the things you're valuing is time and space to think, makes perfect sense to me, but it also, I think, raises a flag, a red flag, about what is problematic in the system. How does one carve out time and space to think in the midst of a very busy work environment? I'm not sure I don't always have the answer to that question.
Dr Angela de Sá:Well, I think the first step Maria is really seeing value in it.
Dr Maria Christodoulou:Yeah.
Dr Angela de Sá:And then there's the permission, of course, and it's very difficult, because when you're faced with sick patients who feels like they can give permission, for you to step out of that space and go and give permission. So it doesn't mean that everything grinds to a halt. In the same way that we don't stop attending to emergencies because some of us have to go home and rest. We never do that. I think we just need to see it more in that way, because, without creating that time to think, that time to strategize, we keep mopping the floor, don't we? We're not really dealing with the problems.
Dr Maria Christodoulou:Tell me about the flamenco dancer.
Dr Angela de Sá:I thought... I n the back of my mind I had that flamenco dancer, and I thought, oh, bloody hell, good, she's forgotten about it. No, no, I always tease. I always say to people in a previous life, I don't know what it is, I have such an affinity to... I just love the music, I love the dancing, I just really do, and I'm always drawn to it. Whenever there's a show I'll go, and I'm sure it's because in a previous life I was a flamenco dancer. So that's the kind of thing that you sort of almost assume, because it's not like any of my parents or family or people that I know, wherever they're passionate about it, I just love it, I just love the music.
Dr Maria Christodoulou:Lovely. I was curious when you mentioned your painting earlier. We can't see it. It seems to be on your side, in the room that you're sitting in, and you said it's been there for about a year and a half. I'm wondering what image you're painting. What is the painting about?
Dr Angela de Sá:This one is sea. I quite like the sort of nature. I'm thinking of the one that I did was a jellyfish, the other one was a moon rising. But there's always that criticism, isn't it, and that would stop it for me. I mean, I used to do these dioramas and I remember the one time this was just after med school.
Dr Angela de Sá:I was then diagnosed with temporal lobe epilepsy, and so the symptoms that you actually get with temporal lobe epilepsy can be quite weird, and I wanted to depict it in this diorama with almost like a sense of a floating ghost. Two rooms, exactly the same mirror images.
Dr Angela de Sá:The one was dark and just painted in black and the other one normal colouring and in it would be a floating image floating through a mirror.
Dr Angela de Sá:The head was sort of like going through the glass of the mirror and on the other side was the same image, but a sort of blackened ghost and just the sense of your mind sort of like going into that space and then coming back out of it again. It was just interesting because I felt so frustrated at the time and this is part of that slightly perfectionist, you couldn't quite get it right, so I just left it, and that's part of it. There is this desire to create and do something, but because it can't be quite exactly how you want it to come out, you kind of walk away from it and you procrastinate and you never go back to it and I actually just want to find that space of ease once again. So it was to take that little self-critic, shove the person away in a cupboard somewhere and just allow yourself to just mess around.
Dr Maria Christodoulou:You're reminding me, years ago I worked with a coach and I was at the time and still relevant in many ways today, I was struggling to write. I have this thing about writing and then I go through phases where I muster up the bravado that now I'm going to write, but it's always clouded by the inner critic and the censoring my own writing and wanting to make sure that I'm not going to offend anybody else with my writing and then worrying that it's not good enough and all of that. And I worked with a coach who made me externalise the critic. So I had to find a way to depict my own inner critic. I used clay and I made a little sculpture and I remember when I was making the sculpture, in my mind my inner critic looked like the character from Maleficent, and I kept trying to make the clay stretch high and be this long, slim figure with a cloak on and it kept like squashing down and collapsing and becoming this quite pudgy, stout woman. And it ended up being this pudgy, stout woman with an apron on and a big hooked nose and kind of with a headscarf on, somewhat reminiscent of like a witchy energy, but also of many of the old women that I had encountered in the village where my parents came from, more traditional, conventional women.
Dr Maria Christodoulou:But I used to keep that little statue on my desk and when I wrote I used to turn her away from the writing. She wasn't allowed to come in until it was editing time. I was allowed to write the first shitty draft, or two or three shitty drafts, and then she could have a say in terms of the editing. But it's still.
Dr Maria Christodoulou:It's like it's such a big thing and I think it's partly also linked to what drives us in our career, or certainly what was driving me was like trying to be perfect, and this fantasy that medicine is exact and science and evidence-based, when actually it is some of those things, but it is also incredibly intuitive and creative and innovative in terms of like really good medicine. But when you were talking earlier about the work ethic and how that still drives you and that even in this few short months, you notice that the pattern of falling into busyness with work stuff is there and that it crowds out the creativity, the artist and the flamenco dancer and all of that, I wondered how it would be to harness that work ethic in service of the creativity. What would emerge if that work ethic was committed to your creative process or your identities outside of medicine?
Dr Angela de Sá:Oh, my word, you know those really humbling moments when you realise you know how much you trip yourself up. It would just be that freedom, ja, that sense of freedom, because you know there are those flow states, those moments where it just comes together so beautifully, there's no self-doubt, everything makes sense, it flows so beautifully. And then you think like, wow, you know, where did that come from? And then you realise that the critic wasn't anywhere around. The reason why we need the critic, we need to find that off switch. That off switch is important. I'm still grappling with that. I really am. While you're talking and when we're talking, I'm sort of thinking more and more that the idea of my little clay figurine there, of my critic, is something I really ought to sort of bring in and put front and centre right here. I'm being creative at home, a t least. I'm being creative in the house. There are lots of things that I'm getting done that I just always put off for years and years.
Dr Angela de Sá:And at least now I'm getting the space to be able to just fix the garden in the way that I want to do it and to redo the house in the way that I wanted it to be done, but I'll get back to the painting. It's about all the creativity. It's being able to express yourself in your work and finding new and innovative ways and look, I do think that I have. I'm bringing new insights into my job. It's making sure one also has the skills to communicate that to people effectively so they see the big vision as well. Finding your inner visionary and being able to connect people with you, and obviously the creative as well.
Dr Maria Christodoulou:I'm reminded of something that my guest on the last episode of the podcast said and that kind of stayed with me and I've been thinking about it a lot.
Dr Maria Christodoulou:She had navigated quite a challenging decision to leave medicine three months into her internship year, and we were talking about how people think it's brave or it's courageous and that actually you get to a point where it's not even a decision you make, like you have to do it, there's no choice, you have to.
Dr Maria Christodoulou:And she said that maybe you don't have to wait for that. Not everybody has to feel that and maybe you don't have to wait until you are burned out or that you've lost yourself completely, as she felt she had done. But maybe you just need to want more for your own life. Obviously, it's relevant for me to reflect on in my own life at the moment, but there's something about it's okay to want more for your own life, it's okay to create the space and the time for those things, and that it takes courage to do that. And I find myself wondering, if you and I were to bump into each other 10 years from now and you were looking back on this time, w hat would you like to be able to say that the 10 years have been about?
Dr Angela de Sá:Obviously different for the different aspects of my life. If we're focusing more on the work part of it, what I would like to bring to medicine is a different perspective, a different way of being a clinician, being a healer, and by that I mean drawing in a lot more of our humanity. I think in doing that we can almost transform the way we engage with our patients. I think it makes it so much easier to step into being somebody who empowers a patient as a clinician. W anting more for ourselves in terms of our lives, I want to say I'm kind of careful about that. It's not really wise of us to be expecting that when you go into a profession like this, that people must sacrifice part of who they are. It's not wise because many of those people start losing touch with that deep human being within them and then the practice of medicine suffers, the patients who are at the receiving end of that kind of practice of medicine suffers, and so we almost as a deliberately intently need to ensure that people who are going into these healing professions are actually able to look after themselves, not just others, because you have to nurture that humanity. If you don't, you end up with a corrupted form of what medicine is or healing is.
Dr Angela de Sá:I mean, I think this is part of it. We know that we can't, from a resources point of view, offer this current medical model to everyone. So if we come at it from the belief that we always have to fix it and make it right and we take away the power to do that from the community, we'll never get it right. The way we come at it from has got to be like the community has got to take this responsibility and then, yes, of course, we are the experts, we can give the advice and the whatever, but the healthy habits have to be installed by the community and that you can't fix 20 years down the line when the person is diabetic. There's got to be a lot more focus on the proactive part of it. So I think our obsession and our focus on the curative is hugely problematic and holding other role players like the food producers and all of that to account are incredibly important.
Dr Maria Christodoulou:A conversation perhaps for another time, but for me it goes right back to the roots of our definition of health, definition of the role of the doctor, our definition of the role of the health system, going right back to the foundations.
Amy Kaye:Absolutely.
Dr Maria Christodoulou:If I asked you what it is you love about being a doctor, what would you say?
Dr Angela de Sá:I mean there are a few things, but if I had to focus on one thing, the opportunity to engage deeply with another human being is clearly something I really appreciate. It's quite a privilege actually, if you think about it, what we get invited into.
Dr Maria Christodoulou:For me, it's almost like the privilege of being a doctor is that we are invited into that deeply intimate space with people. Often in the lowest points in their life.
Dr Maria Christodoulou:It's a huge grace in that, actually.
Dr Angela de Sá:And in knowing that, how important it is for us to be able to take care of ourselves, because you can really get sucked down those spirals.
Dr Maria Christodoulou:Is there anything you hate about being a doctor?
Dr Angela de Sá:With maturity one doesn't do it as much, or certainly wasn't doing it at all. But the physical demands. S leep deprivation part of it was rough when I was doing calls and that sense of always being on. So it's with quite a bit of relief that I walk into work, because that's where I teach the students. I go back to Retreat and I know that I don't have to be really there from six o'clock in the morning checking out the WhatsApp, who's going to be at work, who isn't going to be at work. It's nice not to have to be on all the time. I can have a nice cup of coffee now in the morning as I say goodbye to my kids. They go off to school and my husband and I can just chat for half an hour before starting my work day.
Dr Maria Christodoulou:So your husband and your kids, if I had them in the room with us now, what would they say about you? What's it been like for them to watch you working in this way for so many years? What's it cost them?
Dr Angela de Sá:I can't really say that they've ever really complained. I mean, I think we've been fortunate. My husband's been working from home since COVID, so that's helped quite a bit. I was actually laughing the other day because my one child was saying to me but jeepers, you know, you're like working from home, but you're actually working harder than you did like when you were at work. So I said, well, you never saw me working when I was at work, so how can you tell? I t was also school holidays, they were off and my husband was off. So, relative to them, yes, I was working. I think the appreciation and I can see it in the engagement with the conversations it's the appreciation that now there's energy. N ot that there was never intent or love or wanting to, or it's just that now there's energy and there's ease. I can actually sit and actually have that conversation and as it arises. So I think more presence is probably what they would say. I'm just here, more, not really physically, just more present.
Dr Maria Christodoulou:Yeah, I'm happy to hear that because I know it was an issue for you. You were concerned about not being as present for them as you would like. What have you learned about navigating change that might be helpful for others to know?
Dr Angela de Sá:Yes, I must say I'm quite a champion of it a t the moment. W hen you are feeling yourself pulled into a different direction, don't ignore the call and, importantly, if you can't see your way around the obstacle, go find yourself someone who can give you some space to think that one through and, I think, spend some time thinking about what it is that you would really like to do, and to do it from a space of, not from a space of fear, but from a space of excitement or enthusiasm, or you're being pulled towards something rather than running away from something. Find your space, find your passion. That's so corny, but...
Dr Maria Christodoulou:What's pulling you?
Dr Angela de Sá:I've always loved the mental health space. The mental wellness space is kind of what's pulling me and that's why the coaching was always so appealing. Yeah, but that space, if you see the opportunities for yourself, you know for me to share it with others, that's coming back full circle. It was never psychiatry, it was always like public mental health. Really, that was actually where I was going.
Dr Maria Christodoulou:Right and, in a way, public mental health, including the mental health of the profession.
Dr Angela de Sá:Absolutely.
Dr Maria Christodoulou:So t here's still a personal motivation in who and what we're trying to help, and I include myself in that mix.
Dr Angela de Sá:Yes, absolutely.
Dr Maria Christodoulou:Amy, is there anything you'd like to ask Angela?
Amy Kaye:You were talking about a subject that is very dear to my heart, that I'm very involved in when it comes to creativity and perfectionism and the inner critic and procrastination, and these are all the things that I deal with and aware of.
Amy Kaye:I had a lot to say but I just wanted to listen. I know the conversation needed to happen. One of the things that I do I am an expressive writing coach and a narrative coach, so I help people tell their stories, and one of the things that I facilitate is Julia Cameron's The Artist's Way, and it's the one book that everybody buys that sits on the shelf. It's the one book that sits there for years and years. Everybody goes I'm going to do this and then they don't do it. Or you start doing it and then you don't have accountability or support, somebody to work through you, and then, just like, the painting sits there, the book sits there.
Amy Kaye:And what's interesting is with the artist's way, there are two main features and w hy it's so popular is, there's the morning pages, where you're supposed to write three pages every morning in flow. You don't edit, you just write, and the point is just to write and to get off the mental fluff in the morning and to get into daily writing too. And the other concept is the artist date, when you take yourself out once a week and you just go do something for yourself, that is creative, that lights you up, you connect with your inner child, whatever it is, but it's just something. Even if it's an hour once a week, you do that thing. You do an artist's date by yourself, with nobody else. And what's interesting is, I've run the course for years and I'm going to run it soon again.
Amy Kaye:The people that come on the course are terrified of doing the morning pages. How can I write every morning? I can't. There's no way. I'm not a writer. And there's all this resistance to writing. But they get into it pretty quickly and once they get into the doing the morning pages, that's the one thing that they can't stop doing. They can write every single day, no problem, even though they're not writers as such. But the thing that they actually struggle with, which everybody struggles with, is the artist's date, because we don't see the value in taking ourselves out on a creative date once a week. Because who am I to spend an hour doing something just for the sake of it, just because it might make my life better?
Amy Kaye:The artist's date is the whole thing of oh, but I haven't earned it. I don't deserve to go swim in the ocean, I don't deserve to finish this picture, I don't deserve to. Whatever it is the thing I want to do, I have to earn it. Whereas the writing on the morning pages. I think has to do with oh no, but I can tick that off. So now I'm a good student and I've done the page and I can tick it off. But the artist's date, there's no ticking off of, oh, I did something nice for myself, okay, but I don't deserve that.
Amy Kaye:So it's very interesting. So that whole thing of you want to paint, then you don't paint. It's because there's that thing of the self-value, the value of the art, the value of the experience, etc. etc. There's so much tied up into that. I think it's interesting.
Amy Kaye:The other thing that's fascinating is, who is the healer? We've spoken to all of these people in the medical field that are healers. But there are also so many of them - most of them actually - are creative. That are artists, that are healers, and they're both healers. They're doing the exact same thing. It's alchemy. It's taking pain, whether it's physical pain or mental pain or emotional pain, and it's turning it into something else.
Amy Kaye:And then there's the medical professional that has this identity of being the medical professional, and they're not an artist. And then there's the artist who goes oh, I could never be a medical professional. And that thing of like, t hese are two completely different worlds, but they're actually not. It's just a different perception. And how the narrative around, like those of us that decided to go to medical school and those of us that decided to go to art school, and what that means. O ne gets put on a pedestal because, oh, you're a medical professional, and the other one is, oh, you're an artist, you just threw everything away, you're going to be a pauper, and what those choices mean. It's fascinating. We're all dealing with the exact same stuff. It's just the way you look at this. I don't know if that's helpful in any way, but I just think it's fascinating.
Amy Kaye:You have this idea of who people are. But the more you talk to people, the more you realise that we're all dealing with the exact same stuff. T he doctor that's struggling to make the painting, then there's the artist that's struggling to do whatever the thing is, and about taking the time to go. I'm allowed to do something nice for myself, and, yes, you can work hard. But isn't the whole point that if you work hard, then you must reward yourself? Find the ocean, paint the painting, stop waiting.
Dr Angela de Sá:Absolutely no, you're right, but there are just so many things at the moment, just so many things. Now you're just kind of spoilt for choice. Look, I regard myself as being very blessed in that I have opportunities to do many things that other people don't do or can't do for very different reasons. But I have been toying with that idea of it's almost like when you're obliged or you're being held accountable by someone for that art. I actually have a friend, she's just literally across the road from me and I've often toyed with the idea. But it's funny that you need somebody else to almost feel okay to spend that time with yourself and go to the artist who will then teach you. It's not, it's just about creating that space for yourself.
Dr Maria Christodoulou:I think there's also something about this meta perspective of what we've been conditioned, whether you're an artist or a doctor or both, what constitutes work and what is success, and all those meta-level ideas of those things and all the, in a way, the marginalizing of the creative pursuits and the arts as something separate to the workforce and that if you're working hard, you're working at a profession, it's not at these other frivolous things, which is the legacy of patriarchy. And there is something about what has been assigned value. And for me there's an additional piece if we're talking about the critic and the part of us that doesn't take the next step. Certainly, for me the morning pages are easy. I do that. I've journaled my whole life since I was in high school and the artist's date is a concept that I've got much better at over time, like I go through periods where I do those things and others where I don't. But what feels like the stretch is that next step of making that creative stuff visible to others, so sharing the art or writing the book and putting it out there.
Dr Maria Christodoulou:I can write reams of pages for myself. It happens in these conversations. I have conversations with people all day, often deeply intimate conversations. The minute the record button is on, I start getting tongue-tied because I'm aware that it's for the consumption of somebody else. Somebody else is going to listen. Somebody else's critical lens is going to be or not critical lens, I don't know. The assumption is that it will be a critical lens. That ties up something in me into knots and makes it almost more difficult to just be myself and just be spontaneous and just share, and it shows up in so many different ways.
Dr Angela de Sá:To be truly creative and innovative. You cannot come from a collective space. That true innovation and creativity has to come from the individual, and when you're putting yourself out there, that's always the struggle.
Dr Maria Christodoulou:Interesting y ou say that because just before you were saying how it always makes a difference when there's somebody else either to do it with or to hold you accountable, or to create a space to facilitate it. For me, that's the relational aspect of it, that inner space or that creativity from the inside can emerge in relationship to something, or someone. It doesn't have to be a person.
Dr Angela de Sá:You know what I think it is, Maria, for me, if I'm thinking about it, it's that that person holds the safe space to receive something that is uniquely yours, yours to give to the world. Because that's the angst a lot of the time. It's about you being held back because you think in some way it's going to be criticised or whatever it might be. In fact, you're your own worst critic, but that person holds that space, that safe space for it to kind of almost be birthed, isn't it?
Dr Maria Christodoulou:Sure, maybe part of what we're talking about is exactly what results in awakening doctors. Anything I haven't asked you, Angela, that you want to share?
Dr Angela de Sá:I'm feeling pretty shared out here. I'm feeling pretty solid talking for two hours.
Dr Maria Christodoulou:I did ask you earlier what advice you would have to somebody who is in your situation of wanting to make a change and struggling a bit. But I'm wondering now if you have an opportunity here to share with others what really matters to you and a platform maybe to say stuff that you might not have been able to say in other spaces, like what do you want people to know? Y our colleagues on the one hand, but also the public that are interacting with the colleagues? What message would you like to share with the world?
Dr Angela de Sá:It comes back to humanity, it really does. We need to all be able to get to a place where we are feeling comfortable being ourselves. I think the key thing is really about finding the humanity in each one of us, not losing sight of that for many reasons. I think that's it, you know, just really to look for the humanity in each one of us.
Dr Maria Christodoulou:Anything else from your side, Amy?
Amy Kaye:Something that's sticking with me, Maria. Something you said about the fear of not wanting to put whatever it is that we create out there because of like the world will criticize you or however you perceive it's going to be seen or not seen or shared. A different perspective, which might come across as harsh, but that's my own inner critic stuff coming through now. It's selfish not to share your art with the world because somebody somewhere needs to read the book, look at the painting, feel the feelings, resonate with whatever you've been through and go, o h, I'm not alone, there's somebody else in the world that gets this. So you going, I'm scared because somebody might criticise this. Somebody out there really needs that thing that you need to give, and that's selfish.
Amy Kaye:I hate the word selfish because it's so harsh, but it's about stop worrying about your fear and focus on that person that needs that. Again the alchemy of changing the pain into something. Don't be scared, and criticism is probably more likely to get crickets than you'll get criticism, actually, because nobody is magnifying in on your work the way you are.
Dr Angela de Sá:Or indifference. No, you're right. I mean, that's actually quite a nice way to put it, yeah.
Dr Maria Christodoulou:I have heard that before, Amy, and I've also heard about reframing creativity, actually as an act of generosity. But I think certainly for each of us it will be a different thing. But I know that for me it's around all sorts of conditioned ideas about perfectionism and all of that. I do know that the ideas have value. I have no problem sharing them in the one-on-one space with my clients where I can, and this is the piece that's maybe interesting, where I can regulate the response to what I share, where I can be witness to it, where I can explain it if I need to, where I can help contain it if I have to, as opposed to this open-ended putting something out there like even a podcast and having no idea how it's received or what people think or how they respond. That's an extra edge, but certainly the growing edge.
Amy Kaye:I always think it's interesting. As a writer, you never know who's reading the words.
Amy Kaye:You have this silent relationship. You write the thing, you put it out there. Somebody's reading words. Nine out of ten times, that person is never going to write to you and they're never going to tell you this changed my life. This is amazing. I had an epiphany. I really needed to read that this week. Most people read the thing, go, oh, that's brilliant. And then they go on with their life because I'll get back to it and you never do. As an artist, you have a weird silent relationship with your audience. They're there and they're loving you and they're loving it, but you never hear from them and there's something about just being able to let go of that and going okay, put this thing out into the world. And now the world does with it what it does and that's okay because it's your baby and you want everybody to love your baby as much as you love your baby. And if anybody goes, oh, your baby's so ugly. I mean that's horrific. What do you do? But it's hard, it's really hard.
Dr Maria Christodoulou:Well, Angela, I'm taking it as a good sign, in terms of both your and my creative process, that our conversations veered into this terrain of art and creativity, and our inner critics and all of that. Part of me feels like we've deviated a little bit from my usual focus on get the person to tell their personal story. If you're talking about bigger ideas and concepts and that that's actually what the coaching space is about like moving from the known into the unknown, moving from the space of what is familiar to us and what we are experts at into the space that is somewhat new terrain, and it feels like, in a way, where you are in your life right now kind of on the edge of something new. You've just stepped away from something and you have some ideas about what this next phase will bring, but neither of us actually know what that's going to look like or what it's going to mean, and so I'm really grateful that you were willing to step into the space with us today and to share a little bit of your story and what's been unfolding for you, and also for the real humanity and the thoughtfulness and the care that you bring not only to the conversation, because when you speak, t here's such a sense of like a careful consideration of what you are saying and not saying. I really think our profession can learn a lot from that.
Dr Maria Christodoulou:I'm grateful for a colleague who understands coaching. I find that so collaborative and relational and it makes my journey feel less lonely that people like you are out there now, and I'm excited for you about what this next phase will bring and what it will mean for the profession, for the curriculum, for the students you interact with, and I hope it will be an incredibly generative and creative time that is less about working hard and more about being all of who you are.
Dr Angela de Sá:Thanks very much, Maria. Ja, it's always lovely chatting to you. And thanks, Amy, really been lovely speaking to you too. I think it's sort of like a sense of just that next step.
Dr Maria Christodoulou:And the not knowing what that next step is.
Dr Angela de Sá:And that's fine, and that's fine. Just knowing that we are stepping into that new world.
Dr Maria Christodoulou:Thank you for your time, thank you for being here, thank you for sharing your story and all the best for whatever the next stage of the journey will bring. I'm Dr Maria Christodoulou and you've been listening to the Awakening Doctor podcast. If you enjoyed this conversation, please share it with your friends, f ollow Awakening Doctor on Instagram, Facebook or Spotify, and go to Apple Podcasts to subscribe, rate ,and leave us a good review. Thank you for listening.
