Revolutionising Healthcare: Breaking Free from Transactional Models - Jo’s interview with Alyssa Elgersma

Revolutionising Healthcare: Breaking Free from Transactional Models – Jo’s interview with Alyssa Elgersma

It’s the end of the first season of The Entrepreneurial Clinician Podcast (don’t worry – Jo will be back with season 2 very soon!)

So previous guest Alyssa Elgersma returns to the podcast to turn the tables (or the microphone) on Jo. In this conversation, Alyssa interviews Jo about her career, her life and why Jo is so passionate about changing the way healthcare is structured so that health professionals can build sustainable careers and thrive professionally and personally.

Resources mentioned in this episode:

If you know you need more support, please visit my website at https://jomuirhead.com

Transcript

Alyssa:

Hello, Jo. How are you doing today?

Jo:

I’m doing very well, Alyssa, lovely to see you again.

Alyssa:

Lovely to see you again. So, my name’s Alyssa Elgersma. I will say this. We decided to do this 40 minutes ago, y’all. Yeah. <Laugh>. So yay for us. Okay. The Entrepreneurial Clinician Podcast. This is what I’ve decided to take over because I realised that Jo forgot to interview somebody before the Symposium starts, which is in 16 days or 17 days, depending on where you’re at in the world. And this person is Jo Muirhead.

Jo:

<Laugh>. Thank you. Alyssa.

Alyssa:

The lovely person who decided to come up with it last year, and she had so much fun. We’re doing it again. So, Jo welcome to your own podcast.

Jo:

This feels very strange and very weird, but thank you for having me, <laugh>.

Alyssa:

Awesome. So we’re gonna keep it a little light, a little fun ’cause rarely am I serious, as you know in the last 12 months that we’ve learned about each other. So what makes you confident as a clinician?

Jo:

Oh, Alyssa <laugh>. What makes me confident as a clinician? Oh, where does my confidence come from? So I’ve been doing this work for 30 years, or almost 30 years. And I think that the confidence comes from me now going, I don’t care the diagnosis that you come to me with. I don’t care the level of difficulty that you come to me with. I don’t care. None of that overwhelms me. I don’t care how many surgeries you’ve needed to have or how much horror you’ve seen in the world. If you genuinely want to use me as a resource for change, then we will work out what that change is gonna be. But it’s not something that I was born with or graduated with at all. We used to have these things when we did what we call an initial interview. And it was a big long document that was like a book, and it took you through every question you needed to ask, and you wrote down every answer to all the questions, and then you could formulate your opinion and your report. I don’t even turn up with those anymore. And nothing ever gets missed. My confidence that I know from the person who’s sitting in front of me, I know how to lead that conversation, and I know how to help them stay in that, number one, feel safe and stay present to be able to give me the information that we need that day. And I think the other confidence piece is coming from a place of, I really don’t care about third party agendas anymore. So I don’t care what the insurance company wants me to do. I don’t care what the employer needs me to do. I don’t care what the person paying need me to do. If I’m there to serve you, that’s what we’re gonna do today. Because it certainly doesn’t come from my academics, because the thing I worked out last night, <laugh>, for this entire Symposium, I am the least academically qualified person in the entire symposium. That is not where my confidence comes from.

Alyssa:

So academically, then what are you, what did you train for?

Jo:

<Laugh> This is gonna be my, this is like my dirty little secret. So I have a three year undergraduate degree. Not a four year, not an honours year, not four plus two, three year undergraduate degree. No postgraduate. It’s called a Bachelor of Health Science, majoring in rehabilitation counselling. That is it. You can’t actually get that qualification anymore. <laugh>. It’s now a master’s program.

Alyssa:

<Laugh>. Well, you seem to hit it at the right spot where you didn’t need to go for those extra two years.

Jo:

No, I tried to do some extra stuff. At one stage I thought I wanted to move into the work health and safety space. I lasted six weeks in that. Another time I was gonna go and do my master’s in occupational therapy. I’m just not cut out for academics. I don’t enjoy it and there are some amazing people who do like Dr. Bee Lim, who’s gonna be at the Symposium. She is an incredible mix of that academic versus therapist person. I just get lost in all the information, and I know that my gift to the world is helping people make change and implement. I’m very good at helping people. Well, what do you need to do to get from A to B? Let’s work out a pathway for you. That’s my sweet spot. So I don’t need to write papers on that.

Alyssa:

No, I’m not a paper writer either. I’m thankful for all those people who go for their doctorates, but I also know I’m not one of them. Yeah. So what’s your favourite leisure activity? What do you like to do for fun?

Jo:

Fun. I hate this question. Okay. No, no, it’s okay. I think it’s important to answer because it speaks to my years and years and years of being the burnout queen, which we have apprehended because I didn’t pay enough attention to what we do when we’re not working? So I now have a range of things that fill me with joy. Work is one of those things. I love my work, but I also love my garden. I’m growing orchids at the moment. It’s orchid time of the year. I get very excited about my orchids, <laugh> <laugh>.

Alyssa:

But do you have multiple colours of orchids?

Jo:

I am growing a collection. I am growing a collection of sim cymbidium orchids for anybody who wants to know exactly what type of orchid they are. So I have yellow ones and, and the yellow has a fairly significant, like, the colour yellow for me as a flower has some significance from my childhood. So I love my garden. I love to walk on and just be around the beach, which I live about 80 kilometres from the coast, which feels like a long way. It’s only a long way because in Sydney, which is the major city where I live, we have this thing called traffic. I hate the traffic <laugh>, but it’s not LA traffic. I understand that people, I get that it’s not LA traffic, but it’s still traffic. So Smudge (Smudge is my dog), we will often go for a walk in what we call the bush. That is the forest <laugh>. And that’s just a joy. He just sniffs along and goes and finds things. And I get to be in nature and breathe fresh air. So I enjoy that as well. I’m also quite a crafter. I like doing craft and I really rejected that part of myself for a very long time ’cause I felt like it added no value to humanity. That actually adds value to me. So that’s what I do in my leisure time.

Alyssa:

Great. I like the people who are able to be crafty, okay. Because they create beautiful things and I can just purchase them

Jo:

Nice <laugh>.

Alyssa:

I can support them in that endeavour. So you mentioned you were a rehabilitation therapist.So for me, in the United States, I personally think of like physical rehabilitation after an injury. Is it similar in Australia?

Jo:

Yep. So rehabilitation in the way it was instructed, taught and practised, it’s basically helping somebody manage the impact of a force change on their life. So I’ve chosen to work with people who struggle to return to work or get a job or have work as a part of their life because of something that’s happened. It’s usually a health event or a serious injury or some other type of traumatic event that’s kind of interrupted their life. So I started off doing a lot of work around physical rehabilitation. And the way I explain how a rehabilitation counsellor fits into this whole health state is, if you imagine somebody who’s had a motor vehicle accident, they get carted off to hospital and they need surgery. So the surgeon sews them up, and then the physiotherapist or the physical therapist goes, right, today we’re gonna get you outta bed and we’re gonna walk you around and we’re gonna teach you to walk again. We’re gonna teach you how to use the bathroom. We’re gonna make sure you can get up and downstairs and you go, awesome. So the physiotherapist kind of then walks them out of the hospital on the way out of the hospital, they meet an occupational therapist. And the occupational therapist goes, right now, before we get you home, there’s a few things we need to think about. How are you gonna do your laundry? How are you gonna get the kids in and out of the car? How are you going to rearrange your kitchen for food? How are you gonna get your shopping done? How are you gonna do your banking? So you sit there and you’re with the occupational therapist, and you work out all of these activities of daily living to help you just function and sometimes you need equipment, and sometimes you just need things rearranged, and sometimes you need somebody else to do them for you. And then what happens is you get to a point in your recovery where you kind of go, all right, I know how to live as a person with paralysis or incomplete quadriplegia or a brain injury. I’m kind of getting used to this. And then people wake up one day and they kind of go, what am I gonna do with the rest of my life? And that’s when a rehabilitation counsellor can add an incredible amount of value. Now, that’s when we start talking to people about their purpose. It’s where we get them to re-envision an identity ’cause we don’t want people identifying with their illness all the time and how they wanna turn up in the world apart from being somebody that has an injury or a disability. So there’s a lot of advocacy that goes into the work. There’s a lot of overcoming barriers. Sometimes those barriers are very physical. Like, you can’t work there ’cause we can’t fit your wheelchair in the door, right? We still have some of those barriers. And a lot of barriers are just around people’s perceptions <Laugh> we all deal with that, don’t we? So yeah, that’s a very simplistic way of explaining it. And I know that there’ll be OTs and physios that are listening to it going, that’s not just what we do, but for the sake of brevity and for allowing people to work out how we can all work together.

We’re not at the exclusion of each other. It’s not like you graduate from physical therapy and then you move on to OT. Often, as professionals, we’re working together. It’s called multidisciplinary teams for a reason. So yeah. That’s a very long answer to the question that you asked.

What a lot of people here in Australia will often say is, oh, do you work with people with addictions and drug and alcohol? And I’m like no. Because I’m not a good fit for that population. I come across as one of two things. One is I come across as very judgy mcjudgey. People with addictions do not need any more judgement, and they certainly don’t need it from a treatment professional, right? And the other thing, other way I can come across to that population is very maternal. They don’t need mothering. That’s probably what led them. Anyway, <laugh>. So I’m very quick to say, although there’s rehabilitation counsellors working in that sector and working with those people, I just chose not to be there. It’s just not a good fit for me.

Alyssa:

Hmm. Well at least you found out what’s not a good fit and how you can help others move forward.

Jo:

Yeah.

Alyssa:

So in your past, and you’ve been open about this in other social media spaces, you’ve had a health issue.

Jo:

Yes, I did <Laugh>

Alyssa:

How did you use your skills as a rehab therapist for yourself?

Jo:

<Laugh>. So what Alyssa is talking about here is my episode of bilateral breast cancer, where I was diagnosed in February of 2020 and went through four major surgeries, including amputation and reconstruction and chemotherapy. And we are still living out the consequences or the effects of treatment today. So how did I use that? So, well, one of the things that I knew, it got to a point where I couldn’t rehabilitate myself and I needed the support from other people and letting other people in. So, and then I worked out, oh, that’s what I asked clients to do all the time. That’s really scary.

So one of the key points for me was understanding that activity helps with recovery. And I have been taught for a long time that that means physical activity. But what I learned by a process of elimination and curiosity is that physical activity doesn’t have to mean exercise. So I became very vigilant about apprehending self talk around, you’re not moving enough. You’re not walking far enough. You’re not in the gym enough ’cause I felt like I was failing at my rehab. And then I have a gorgeous friend in my life who’s also a colleague. Her name is Kylie Warry, and she’s a bit of a resilience guru. She cared and loved me enough to actually go, can I teach you about how you activate resilience? Because I know it’s what you’re gonna need ’cause she’d actually been through the same thing seven years before. And she helped me do an assessment and helped me understand what my factors for activating resilience were. Which is where I was able to fall in love with my crafting again, because sitting down and crochet the crochet, I was crocheting squares together to make rugs. Because there’s a gorgeous woman in my community, her name’s Debbie O’Connor. And she runs this challenge every year in winter so that people in the community can come together. And we make blankets for people who live rough. And she gives them to homeless shelters. She gives them to domestic violence shelters. She gives them to people at risk of homelessness, people who can’t afford it to pay their electricity bills. And over the years, she’s built this thing from let’s make 50 blankets to this year we made over 600.

Alyssa:

Congratulations.

Jo:

Yeah. And during my cancer treatment, Debbie would drive to my house, drop off a bag of squares that needed to be crochet together, and I would just spend hours putting them together. It made me feel good ’cause I was a part of something else, something bigger than me. It gave me something to do with my hands. And if you’re a knitter or somebody who crochets you can, you will also understand the meditative effect that that can have on you. And that was incredibly powerful and healing for me being a part of that. So that’s how I use some of my rehabilitation counselling knowledge in my own recovery. <Laugh>

Alyssa:

You putting the skills to us. ’cause Let’s be honest, counsellors can be kind of lousy at that.

Jo:

Yeah. There are other things about that whole experience that I’ve been lousy about. And one of those was feeling like I was failing. We’ve become very good at, in my industry, at prescribing activity and using it as like, you have to turn up to this many hours at work and work for this much time and do these many activities, or you have to do this much exercise, or you have to go and do this much meditation. It becomes very transactional and very prescriptive. And I don’t think I had appreciated at all the amount of overwork and over-functioning that can turn up when we continually tell people, do this activity, do this thing, do this thing, do this thing, do this thing. I don’t think we’re reinforcing anything positive there.

Alyssa:

Yeah. It doesn’t because what’s the definition of insanity?

Jo:

Hmm. Yeah.. Nicely done. Thank you for that <laugh>.

Alyssa:

So you asked me this when I was on your podcast for myself. If money were no object, what would you change in the mental health industry?

Jo:

Oh, good lord. I did have a few minutes to think about this one, Alyssa, so thank you for that. I think I fundamentally wanna change, I wanna change a system that we have created that is all about the transaction. So we need to create a way of working that enables the people doing the work to be safe and secure and not burn out. So we need a way of working that allows us to individually acknowledge I am at my best when I see this many clients in a day. I am at my best when I do these types of activities for self-care during the day. I am at my best when I take this much time off during the day. I am at my best in the mornings or the afternoons.

We have a couple of things going on there, which is <laugh>, thanks to the automation of Henry Ford. We are still operating in that, by the way, where it’s basically we exchange time for money. Like, how many widgets can I sell in a day? How many widgets can I make in a day? And for health professionals, that turns up in how many clients can I see in a day? And we exchange time for money. And we usually do that on a session by session basis, which is unhelpful. But it’s manageable. We can manage that. We can manage time, and we can manage output. So in an industrial economy that works brilliantly. We’re not in an industrial economy anymore. We’ve also got clients coming to us now with such significant pain that we need more time and resources to learn and become better at helping them navigate those things. But we weren’t taught that. So I’m assuming you’re somebody going through licensure at the moment. I’m assuming that every time you talk about a client, it’s always about a single issue. Am I correct? Like, it’s usually a client who comes with depression?

Alyssa:

Yes, yes. Generally,

Jo:

Yeah. A client comes with grief.

Alyssa:

Yes. We focus on the presenting problem.

Jo:

Yeah. Just one.

Alyssa:

Yes, singular.

Jo:

It’s singular. Yeah. So I was the same. So that hasn’t changed in 30 years. But I have never met a person with a single issue.

Alyssa:

Neither have I.

Jo:

No, we haven’t. But we’re taught, all of us are taught, and this is why you will often feel like you’re just a number or feel like you’re just a part of a process because the person who’s trying to treat you goes, you turned up for an ankle injury. I need to deal with the ankle injury because that’s what you turned up for. And that’s what people are expecting me to do. Instead of going head, shoulders, knees and toes, knees and toes, head, shoulders, knees and toes, knees and toes. So we need to actually really create the space and the way for us to present as whole people. In Australia, we still talk about the biopsychosocial model. You talk about that in the US too. We like to say that we do it. No, we’re not, because systemically we’re not. We can’t. In some jurisdictions here in Australia, I’m allowed to report on the bio-psychosocial barriers. I can say what they are, but I’m not allowed to do anything about them.

So I’ll give you an example. Before I left the workers’ compensation industry here in Australia, this was the case that actually made me leave. It was a young kid. He was 17 or 18, he was an apprentice. So he was an apprentice chippy. A carpenter. He’d been on the work site and he had broken his arm. So the insurance company in their algorithm, predictive state was going six weeks, he’ll be fine, right? ’cause It takes six weeks for a bone to heal. And then we know you need to do strengthening activity and he’ll be fine. So in their head, a 17 year old well adjusted healthy kid. So months later this kid hadn’t returned to work and was obviously being very evasive. So I spoke to him because that’s my job. And I said, tell me what happened on the day of injury? How he broke his arm. He put his arm up to deflect an electric saw that his boss had thrown at him because his boss was angry at him.

Alyssa:

<Laugh> So a bit more intense than an insurance company would ever think of.

Jo:

Yes. So I went, oh, there’s no wonder you don’t wanna go back. What do you wanna do with this information? Like, do we wanna try and mediate with your boss? Cause there’s this whole thing that we’re supposed to go, do you wanna try and mediate? I could organise for me to come and meet with you. Meanwhile, I’m sitting there going, I don’t think I wanna meet with this boss either. But something’s obviously gone down on this work site where it makes it permissible for this guy to act this way. And this young kid, probably his first job, 17, puts his arm up to deflect this piece of metal coming at him and it breaks his arm. So everything about work has stopped being safe. So I get on the phone and then speak to the insurance company ’cause that’s my job. Hey, we’ve got a bit of an issue here. This is what’s going on. I need to get up there. So they’re gonna have to pay for me to travel and they’re gonna have to pay for me to go and do this thing. But the person at the end of the phone goes, no, it’s a broken arm. He’ll be fine. He just needs to get back to work. We are just gonna start declining the claim.

Alyssa:

Oh, so they’re thinking very inside the box.

Jo:

That’s right. But I use that as quite an extreme example, number one, because it totally radically changed the way and how I work cause that gave me permission to go. Yeah. That’s why none of this tends to work. But we tend to see this a lot in our day-to-day practice. Now we are very siloed, we are very insular, we are terrified of making mistakes. We weaponise words like professionalism and ethics against each other all the time. And yet we’re trying to operate in an environment, especially during and post pandemic now where we have got nothing but constant change. Nothing but civil disruption. We’ve got the ill health effects, the social effects of social media, the social effects of wrong news, the social effects of the people being cancelled and minimised and how do we operate in this world where we as health professionals, we’re still trying to work this out, yet we are still operating in a structure that says, you’ll see all the people who need your help today, we will pay you on how many people you get to see today. I used to get so excited because my performance metrics were always billable hours. I would get so excited when I could bill more than I could work. I hacked the system. I’m not being fraudulent. I was never fraudulent, right? There were just ways that you could do that. And I’m not gonna go into that now, but that would make me so excited. But what that would lead me to is in four weeks time, having more reports than I knew what to do with behind in all of my notes, migraines out the wazoo and feeling like I needed to do nothing but work all the time to make up for it.

Alyssa:

Yeah. And you had a family.

Jo:

I was a single mum at this time, yeah.

Alyssa:

<Laugh>, you have spoken very fondly of your child.

Jo:

Yeah. He’s great. He’s an awesome human being. And, we’ve worked through that stuff together. So answering your question, what would I change? I think we know that systemically and we know structurally there are really big problems. We don’t understand what they are. We are not gonna change. Like if we wait for those to change, we are going to be having people writing randomised controlled trial studies retrospectively over 30 years, showing us how our work is unhealthy. And this is what I’m actually talking about at the Symposium. I’ve got this research, I’ve got the data, I’ve got the statistics. Some of the statistics I’m not gonna share in the Symposium because it actually demonstrates that health professionals are currently dying by suicide at a higher rate than most other professions, particularly women. Some of those statistics are as high as 40%.

Alyssa:

That’s high.

Jo:

And this was before the pandemic.

Alyssa:

Oh, yeah.

Jo:

So bit of a trigger warning, which probably should happen before we say those words. So I just wanna help people understand that the work that we are doing has changed and the way we need to turn up in the world and the expectations of us has changed, but the way we are thinking about ourselves and the execution of what we do has not changed. And the only way we’re going to create the change that we need is if we start to take responsibility for that.

Alyssa:

Yeah. Well, there you go.

Jo:

<Laugh>

Alyssa:

Another bit of a little lighter note. You’re sharing all of your wisdom and being your awesome self. But what are you drinking out of your cup today?

Jo:

Ah, well, right at this very point in time, this is homemade ginger and lemongrass tea. But if we were together in a cafe, I would be ordering a double macchiato on almond milk because that’s where I’ll be going immediately after we finish this conversation, is to go and make myself one of those <laugh>. But yeah, my stomach needed something a little bit more soothing on it before I hit it with another double shot today.

So Alyssa, I’m gonna turn the table on you right now. What have you learned about me today that you possibly didn’t know before this conversation?

Alyssa:

I learned that confidence takes time, whether it’s professionally or personally because I’ve met all of my mentoring clinicians well into their professional lives. And I’m sitting here getting ready to start going. I don’t think I’ll ever be that confident.

Jo:

Yeah. And you will be. You’ll be surprised. It’ll just turn on one day and you’ll just go, oh, I don’t worry about that stuff anymore ’cause that’s what it was like for me. I just started turning up to first appointments with clients without a notebook, totally confident that I wouldn’t miss anything. I was like, when did this person arrive? And then you second guess yourself, so you sit in the car afterwards or madly typing your report afterwards. But I think other people would say something very similar. And you also know that if you miss something or you forget something, you can always go back and ask again. You can always go back and ask again. Having to ask the same question twice does not make you a poor clinician. <Laugh>.

Alyssa:

Yeah.

Jo:

That’s really cool. Well, Alyssa, thank you so much for making this happen in such short notice, in like 40 minutes worth of preparation time. That’s been awesome. I appreciate it.

Alyssa:

Oh, and I gotta hang out with you.

Jo:

You’re very, very cool. I appreciate that. So, for anybody who is watching or listening today, we have been talking about this thing called the Symposium. It is the 2023 International Future Proofing Health Professional Symposium. It’s all about giving health professionals an opportunity to start thinking about their future, how they wanna turn up in the years to come. And so that we can be preparing for that now ’cause goodness, something knows we’re gonna be needed. No amount of AI is gonna take us away. It’s just not gonna be possible. So until next episode, go be your awesome self <laugh>.