1 00:00:00,000 --> 00:00:15,120 A half-finished lemonade tells me all I need to know about yesterday 2 00:00:15,120 --> 00:00:18,400 You had a name for this, didn't you? 3 00:00:18,400 --> 00:00:22,960 Well I was gonna, I was just, the working title was Miller vs Berger 4 00:00:22,960 --> 00:00:27,360 and me challenging your nonsense basically 5 00:00:27,360 --> 00:00:30,400 We'll see how we get on 6 00:00:35,680 --> 00:00:38,720 Berger, do you mind if I call you Berger? 7 00:00:38,720 --> 00:00:40,160 No, no, go ahead 8 00:00:40,160 --> 00:00:43,520 What's your general at work, how do people refer to you? 9 00:00:43,520 --> 00:00:46,320 Do you get Dr Berger in your phone? 10 00:00:46,320 --> 00:00:52,880 I get, increasingly the junior residents are calling me Dr Berger 11 00:00:52,880 --> 00:00:55,520 I can ask them to call me David however many times I like 12 00:00:55,520 --> 00:01:00,240 but I think I've become more grey-haired and more fierce 13 00:01:00,240 --> 00:01:03,600 so now they feel they have to call me Dr Berger 14 00:01:03,600 --> 00:01:06,240 but yeah, no, whatever, you can call me Berger 15 00:01:06,240 --> 00:01:08,080 lots of people call me Berger 16 00:01:08,080 --> 00:01:12,480 All right Berger, so when was the last time someone thought 17 00:01:12,480 --> 00:01:15,200 that you might have been too young to be their doctor? 18 00:01:15,200 --> 00:01:18,960 I was reflecting on this myself the other day 19 00:01:18,960 --> 00:01:20,640 Yeah, well that would be never 20 00:01:20,640 --> 00:01:23,280 when I was a medical student they thought I was the registrar 21 00:01:23,280 --> 00:01:26,000 so yeah, no, that's never 22 00:01:26,000 --> 00:01:28,960 I had more the other problem where I used to be asked 23 00:01:28,960 --> 00:01:32,560 for the newspaper when I went in to see my patients 24 00:01:32,560 --> 00:01:34,800 and have the newspaper 25 00:01:36,640 --> 00:01:38,320 but there are more recent times 26 00:01:38,320 --> 00:01:41,840 I can imagine you looked pretty baby-faced Andrew 27 00:01:41,840 --> 00:01:45,120 I did, yes, and underdeveloped 28 00:01:45,120 --> 00:01:51,280 and I in fact these days are disappointed with how 29 00:01:51,280 --> 00:01:55,600 reassuring my arrival is to patients when they see me 30 00:01:55,600 --> 00:02:00,480 and they realize I'm not the new doctor on first sight 31 00:02:00,480 --> 00:02:01,760 but I take it as reassuring 32 00:02:01,760 --> 00:02:05,760 I've got the double whammy in Australia 33 00:02:05,760 --> 00:02:09,280 in that I have aged grey hairs 34 00:02:11,040 --> 00:02:13,280 a certain amount of convective gravitas 35 00:02:13,280 --> 00:02:14,960 and a British accent 36 00:02:14,960 --> 00:02:20,720 which actually confers another level of status actually 37 00:02:20,720 --> 00:02:22,480 which I didn't realize when I moved here 38 00:02:22,480 --> 00:02:25,680 It gives that standard British accent 39 00:02:25,680 --> 00:02:28,960 does give a lot of reassurance to those of us in the colonies 40 00:02:28,960 --> 00:02:31,440 that you must know what you're talking about 41 00:02:31,440 --> 00:02:33,440 because you're the ones who walk 42 00:02:33,440 --> 00:02:33,920 Exactly 43 00:02:33,920 --> 00:02:34,960 Yeah, okay 44 00:02:36,320 --> 00:02:41,120 So there's a lot of people who know who you are 45 00:02:41,120 --> 00:02:43,680 and a lot of those will be listening to the podcast 46 00:02:43,680 --> 00:02:46,880 but who've never had a conversation with you 47 00:02:46,880 --> 00:02:49,600 and so I thought it would be useful to do so 48 00:02:49,600 --> 00:02:54,160 and I suppose my first question 49 00:02:54,160 --> 00:02:56,720 first proper question will be what's the point of view? 50 00:02:57,600 --> 00:03:00,000 What is it that you are for? 51 00:03:02,240 --> 00:03:09,040 Yeah, I mean I'm pretty bolshy in the sense of 52 00:03:09,040 --> 00:03:15,840 I've always been a grumpy old man 53 00:03:19,760 --> 00:03:24,320 but allied with that I'm quite the idealist 54 00:03:24,320 --> 00:03:25,840 and actually went into medicine 55 00:03:26,400 --> 00:03:30,640 for very just naively idealistic reasons 56 00:03:30,640 --> 00:03:32,800 which I think I've kept 57 00:03:32,800 --> 00:03:39,040 The point of me is that I have a fairly wide ranging knowledge 58 00:03:39,040 --> 00:03:39,840 and vision 59 00:03:39,840 --> 00:03:44,400 I have a wide experience in medicine 60 00:03:44,960 --> 00:03:47,840 and I have no vested interests 61 00:03:47,840 --> 00:03:53,200 or at least no position to protect within the medical hierarchy 62 00:03:53,200 --> 00:03:55,040 I'm effectively a medical nobody 63 00:03:56,240 --> 00:04:01,360 So I don't have an academic position 64 00:04:01,360 --> 00:04:05,840 I'm not a medical politician 65 00:04:05,840 --> 00:04:15,120 and yet I'm able by dint of sometimes being outrageous 66 00:04:15,120 --> 00:04:19,840 and being categorical to say things 67 00:04:19,840 --> 00:04:22,800 that many other people would like to say 68 00:04:22,800 --> 00:04:25,680 and that's the point of me 69 00:04:25,680 --> 00:04:32,640 That's the point of me to be an annoying thorn in the side 70 00:04:32,640 --> 00:04:34,960 I was accused yesterday by a very 71 00:04:34,960 --> 00:04:40,320 or not yesterday, last week by a very senior Australian doctor 72 00:04:40,320 --> 00:04:44,560 very very prominent of just being somebody who throws grenades 73 00:04:44,560 --> 00:04:47,920 Well in any war you sometimes need a grenade thrower 74 00:04:49,280 --> 00:04:54,000 Yes but you're not normally throwing them at the generals of your own army are you? 75 00:04:54,000 --> 00:04:56,880 So you've found yourself in a position of needing to 76 00:04:58,160 --> 00:05:01,600 I guess come out from a comfortable position 77 00:05:01,600 --> 00:05:03,040 that we're all in in the profession 78 00:05:03,040 --> 00:05:04,720 which is that we're down in the trenches 79 00:05:04,720 --> 00:05:06,320 we're getting on with our daily job 80 00:05:08,240 --> 00:05:13,920 Sometimes I feel like a medical degree is a bit of a franchise 81 00:05:13,920 --> 00:05:18,080 that gives you a monopoly and an income and a trade to work 82 00:05:18,080 --> 00:05:24,160 So how uncomfortable has it been for you to be having to 83 00:05:26,560 --> 00:05:28,240 get up and make your morning coffee 84 00:05:28,240 --> 00:05:30,880 and go out and make life difficult for the authorities? 85 00:05:32,480 --> 00:05:37,040 Yeah I mean it's been very uncomfortable at times as you well know 86 00:05:37,040 --> 00:05:39,120 because you've been a staunch defender of mine 87 00:05:39,120 --> 00:05:40,560 which I really appreciate 88 00:05:44,000 --> 00:05:47,520 You're dead right when you say that the profession 89 00:05:47,520 --> 00:05:49,840 the medical degree is essentially a franchise 90 00:05:49,840 --> 00:05:53,840 and it's a hell of a money-making franchise 91 00:05:53,840 --> 00:05:58,960 it confers status, it confers wealth, respectability 92 00:06:00,480 --> 00:06:02,960 it's the acme of achievement for many parents 93 00:06:02,960 --> 00:06:07,040 to see their child become a well-respected wealthy doctor 94 00:06:08,640 --> 00:06:16,560 But like I said I am an absurd idealist 95 00:06:16,560 --> 00:06:18,240 and actually we were brought up 96 00:06:18,880 --> 00:06:21,680 when I trained in medicine in London in the 1980s 97 00:06:24,080 --> 00:06:26,000 I didn't appreciate it at the time 98 00:06:26,000 --> 00:06:32,400 but we had a strong inculcation of the great 99 00:06:34,000 --> 00:06:36,560 of the works of the great physicians of the past 100 00:06:37,600 --> 00:06:39,120 I went to St George's hospital 101 00:06:39,120 --> 00:06:40,480 I trained at St George's hospital 102 00:06:40,480 --> 00:06:45,920 which was where Jenna first conducted a smallpox inoculation 103 00:06:45,920 --> 00:06:47,920 an unsuspecting nine-year-old 104 00:06:50,000 --> 00:06:55,760 and so we were really brought up in that heritage 105 00:06:55,760 --> 00:06:59,040 and one of tremendous idealism 106 00:07:00,000 --> 00:07:06,720 and I'm so old-fashioned that I forgot to forget the idealism 107 00:07:06,720 --> 00:07:14,080 and so I find myself in a situation where I have very strong 108 00:07:14,800 --> 00:07:18,720 beliefs about the role of the profession towards the public 109 00:07:18,720 --> 00:07:24,400 and in public health and those in fact do not chime 110 00:07:24,400 --> 00:07:29,280 with the majority direction of the profession 111 00:07:29,280 --> 00:07:36,240 which seeks a route of accommodation and expediency 112 00:07:36,240 --> 00:07:40,320 with the prevailing forces and medicine is political 113 00:07:40,320 --> 00:07:46,320 and there's the great quote from Virkhoff about medicine 114 00:07:46,320 --> 00:07:49,760 being politics by another name and it really is 115 00:07:49,760 --> 00:07:52,080 and everything we do is political 116 00:07:52,080 --> 00:07:56,160 every prescription we write has a political aspect to it 117 00:07:56,160 --> 00:07:59,840 every just simply everything we do 118 00:08:00,720 --> 00:08:06,720 and there's a tacit agreement that will ignore that aspect 119 00:08:07,600 --> 00:08:09,680 and I can't ignore that aspect 120 00:08:09,680 --> 00:08:13,120 and so I feel very strongly that the duty of the physician 121 00:08:13,120 --> 00:08:19,520 is to present to the public a vision of health 122 00:08:19,520 --> 00:08:23,200 and a vision of public health that serves them 123 00:08:23,200 --> 00:08:30,800 and not for instance corporate masters so I mean one of the 124 00:08:30,800 --> 00:08:35,680 I don't want to descend into the cynicism of Chekhov 125 00:08:35,680 --> 00:08:43,040 who I think it was said that you know he hates doctors 126 00:08:43,040 --> 00:08:45,600 more than lawyers because lawyers are thieves 127 00:08:45,600 --> 00:08:49,200 but doctors are thieves who also want to kill you 128 00:08:49,200 --> 00:08:55,600 and so what proportion of the jungle organism 129 00:08:55,600 --> 00:09:02,960 of the healthcare system do you think is going about things 130 00:09:02,960 --> 00:09:07,600 in goodwill towards patients with one eye on the cash register 131 00:09:07,600 --> 00:09:11,680 and making sure the business works and what proportion 132 00:09:11,680 --> 00:09:15,280 is simply self-promoting do you think it is the same as 133 00:09:15,280 --> 00:09:19,920 or worse than other industries? 134 00:09:19,920 --> 00:09:26,320 I think there's a very shining brand that has to be protected 135 00:09:27,200 --> 00:09:30,560 I think there is a degree of hypocrisy 136 00:09:30,560 --> 00:09:33,840 that is much much greater than in other industries 137 00:09:35,840 --> 00:09:41,040 you know doctors are not they're not they're not 138 00:09:41,040 --> 00:09:46,080 they're not thieves and bastards who are you know 139 00:09:46,080 --> 00:09:50,880 just out to scam the public a few are but not the majority 140 00:09:50,880 --> 00:09:58,000 but there is an underlying willingness to compromise 141 00:09:58,000 --> 00:10:01,680 on principle for the sake of an easy life 142 00:10:02,320 --> 00:10:06,640 and to keep the cash rolling in and the lifestyle flowing 143 00:10:06,640 --> 00:10:11,280 I think that's true every aspect of society 144 00:10:11,280 --> 00:10:13,440 so I suppose the notion that we're challenging 145 00:10:13,440 --> 00:10:17,920 is this reverential status have been given unquestioningly 146 00:10:17,920 --> 00:10:22,080 yes and that's the brand that's we trade on the brand of 147 00:10:22,080 --> 00:10:28,800 we are these selfless noble heroes with a higher calling 148 00:10:28,800 --> 00:10:32,240 and we trade on that brand 149 00:10:32,240 --> 00:10:37,040 but really the reality is a bit different in that the only self 150 00:10:37,040 --> 00:10:40,640 here are actually you and me and the rest of them are 151 00:10:40,640 --> 00:10:46,560 exactly the rest of them are not to what degree is it simply 152 00:10:46,560 --> 00:10:48,080 following the leader? 153 00:10:48,080 --> 00:10:53,280 Well I think if you talk to the medical leaders they say 154 00:10:53,280 --> 00:10:57,280 well you know this you know like when I talk to the medical 155 00:10:57,280 --> 00:11:02,160 leaders they say well you know this is the only way 156 00:11:02,160 --> 00:11:05,840 to do it and I talk to medical leaders they say well you know 157 00:11:05,840 --> 00:11:09,520 you're right David of course but our membership won't support 158 00:11:09,520 --> 00:11:12,560 that so the leaders would say that they're following the 159 00:11:12,560 --> 00:11:17,440 membership and so I think you get into this vicious circle 160 00:11:17,440 --> 00:11:21,520 whereas actually true leadership is to inspire people 161 00:11:21,520 --> 00:11:23,600 to go to a place that they didn't want to know that they 162 00:11:23,600 --> 00:11:27,520 wanted to go to and I think we see very little of that in 163 00:11:27,520 --> 00:11:30,880 medicine I think we see very little of that in general in 164 00:11:30,880 --> 00:11:33,040 politics in society. 165 00:11:33,040 --> 00:11:33,840 Absolutely. 166 00:11:33,840 --> 00:11:34,880 These days. 167 00:11:34,880 --> 00:11:36,880 Politics is the art of the achievable. 168 00:11:36,880 --> 00:11:41,600 I don't see any great objection to for example the dropping of 169 00:11:41,600 --> 00:11:45,920 masks in health care at the moment which seems to me to be 170 00:11:45,920 --> 00:11:49,360 problematic how do you analyze that? 171 00:11:49,360 --> 00:11:52,640 And again that comes back to my this this challenging this 172 00:11:52,640 --> 00:11:58,080 notion that that we doctors are somehow these special beings 173 00:11:58,080 --> 00:12:01,200 with higher morals higher values I don't think we are I 174 00:12:01,200 --> 00:12:05,120 also don't think we have higher insight. 175 00:12:05,120 --> 00:12:11,120 So I think that's what you know multi we're as bad as multi-step 176 00:12:11,120 --> 00:12:15,280 reasoning and following through on the consequences of that 177 00:12:15,280 --> 00:12:18,560 multi-step reasoning as the rest of society. 178 00:12:18,560 --> 00:12:22,560 So what would you do to improve that because it seems to me we 179 00:12:22,560 --> 00:12:27,840 have a regulatory system which is exactly to me analogous to 180 00:12:27,840 --> 00:12:30,960 the legal system in general society and that in that we live 181 00:12:30,960 --> 00:12:35,600 in the shadow of it rather than ever really interacting directly 182 00:12:35,600 --> 00:12:35,920 with it. 183 00:12:35,920 --> 00:12:41,120 I think that that comes back to the massive gap between work as 184 00:12:41,120 --> 00:12:42,880 imagined and work as done. 185 00:12:42,880 --> 00:12:49,040 So the things that we do and have to do on a daily basis to 186 00:12:50,800 --> 00:12:53,600 deliver the most appropriate care to patients are very 187 00:12:53,600 --> 00:13:00,080 different to how for instance the regulator would understand 188 00:13:00,080 --> 00:13:00,880 what we do. 189 00:13:00,880 --> 00:13:07,600 I mean the mayhem of an emergency department at times it 190 00:13:07,600 --> 00:13:10,640 just has to be seen to be believed. 191 00:13:10,640 --> 00:13:13,840 I mean we had a riot in the waiting room a couple of weeks 192 00:13:13,840 --> 00:13:18,960 ago a literal riot and in this it was the patients on that 193 00:13:18,960 --> 00:13:25,600 occasion but you know so in that context delivering care is 194 00:13:25,600 --> 00:13:30,800 extremely difficult and those kinds of considerations the 195 00:13:30,800 --> 00:13:33,520 considerations in the real world are very, very different. 196 00:13:34,400 --> 00:13:37,760 So yes you're right there's a huge amount of theatre and 197 00:13:37,760 --> 00:13:42,880 there's a huge amount of people simply doing what has to be 198 00:13:42,880 --> 00:13:46,400 done irrespective of what regulations are. 199 00:13:46,400 --> 00:13:49,840 I mean just the concrete example of this so people can 200 00:13:49,840 --> 00:13:57,760 understand we're not allowed to send photos of patients by 201 00:13:57,760 --> 00:13:58,720 insecure means. 202 00:14:00,480 --> 00:14:02,720 So if you've got a patient with a burn. 203 00:14:02,720 --> 00:14:04,640 That sounds like a very good idea. 204 00:14:04,640 --> 00:14:06,400 It sounds like a great thing. 205 00:14:06,400 --> 00:14:08,880 I'm in the committee now and I'm voting with all the other 206 00:14:08,880 --> 00:14:09,760 committee members. 207 00:14:09,760 --> 00:14:12,400 Actually we're not even having a vote at the safety committee. 208 00:14:12,400 --> 00:14:13,760 Somebody just suggested this. 209 00:14:13,760 --> 00:14:16,480 We're all going yeah that sounds about right. 210 00:14:16,480 --> 00:14:19,840 It's absolutely obvious that you want the most secure means 211 00:14:19,840 --> 00:14:23,440 of transport of confidential patient information but it's 212 00:14:23,440 --> 00:14:24,560 one o'clock in the morning. 213 00:14:24,560 --> 00:14:26,240 You've got a patient with severe burn. 214 00:14:26,240 --> 00:14:27,680 You've got a multi-trauma. 215 00:14:27,680 --> 00:14:28,480 You need advice. 216 00:14:29,760 --> 00:14:32,320 You've got a bone sticking out of the leg. 217 00:14:33,200 --> 00:14:37,040 The orthopedic surgeon wants to see a picture of that leg 218 00:14:37,040 --> 00:14:42,560 right now and we're not allowed to send for instance 219 00:14:42,560 --> 00:14:49,360 by mobile phone by a text message and there's supposedly 220 00:14:49,360 --> 00:14:53,040 some kind of secure mechanism by which these photos can be 221 00:14:53,040 --> 00:14:53,760 sent etc. 222 00:14:53,760 --> 00:14:57,760 In practice that does not exist in any way that I have ever 223 00:14:57,760 --> 00:14:58,800 come across. 224 00:14:58,800 --> 00:15:03,840 So every time that a doctor sends a photo of a patient in a 225 00:15:03,840 --> 00:15:07,360 critical situation to enhance the patient's care with the 226 00:15:07,360 --> 00:15:10,240 consent of the patient they're breaking the rules. 227 00:15:10,240 --> 00:15:13,120 So they stick their neck on the line every day to do that. 228 00:15:13,120 --> 00:15:16,240 And that's the gap between work as imagined and work as done. 229 00:15:16,960 --> 00:15:20,240 I mean I think the thing to say is people are inherently good 230 00:15:20,240 --> 00:15:23,840 and that's the I do believe that and they inherently want 231 00:15:23,840 --> 00:15:25,040 to do the right thing. 232 00:15:25,040 --> 00:15:28,240 There is an element of idealism for anybody who goes into a 233 00:15:28,240 --> 00:15:30,560 health profession and they want to do the right thing by the 234 00:15:30,560 --> 00:15:35,440 patient but it's a question of surviving within the 235 00:15:35,440 --> 00:15:39,040 organization and I think it's you that's referred to the 236 00:15:39,040 --> 00:15:43,120 large health bureaucracies as self-healing organisms and 237 00:15:43,120 --> 00:15:48,480 indeed they are such that if you want to get on you have to 238 00:15:52,160 --> 00:15:58,000 behave in a way that supports the functioning of the 239 00:15:58,000 --> 00:15:58,640 organism. 240 00:15:59,520 --> 00:16:03,040 Well what can a patient do someone who's out there who's 241 00:16:03,040 --> 00:16:06,960 got long COVID at the moment what's their best hope in 242 00:16:06,960 --> 00:16:10,080 approaching this sort of Kafkaesque how do they find the 243 00:16:10,080 --> 00:16:13,440 people who will do the best for them in the face of a difficult 244 00:16:13,440 --> 00:16:16,240 system combined with a difficult patient problem. 245 00:16:17,360 --> 00:16:21,360 Relentless questioning and relentless advocacy and that 246 00:16:21,360 --> 00:16:25,280 will piss a lot of people off but it is the squeaky wheel 247 00:16:25,280 --> 00:16:29,360 that gets the noise and if you find that you're being fobbed 248 00:16:29,360 --> 00:16:34,400 off ignored you simply have to put the case more strongly. 249 00:16:34,400 --> 00:16:38,560 I do not think that we have for all the rhetoric a patient 250 00:16:38,560 --> 00:16:43,120 centered healthcare system and there is no doubt that many 251 00:16:43,120 --> 00:16:49,600 people get marginalized for the sake of the smooth running of 252 00:16:49,600 --> 00:16:53,040 the system so for the individual patient I'm afraid there is no 253 00:16:53,040 --> 00:16:58,160 alternative to being polite but firm and going this is not what 254 00:16:58,160 --> 00:17:01,360 I need I've got more questions can you please answer them blah 255 00:17:01,360 --> 00:17:01,760 blah blah. 256 00:17:01,760 --> 00:17:04,480 That's all you can do. 257 00:17:04,480 --> 00:17:08,560 Perhaps it's best that patients come in a bit a bit skeptical 258 00:17:08,560 --> 00:17:12,080 about their healthcare provider rather than assuming from the 259 00:17:12,080 --> 00:17:14,720 get-go that the first doctor they see is going to know what 260 00:17:14,720 --> 00:17:18,320 they're talking about and going to take their problem seriously 261 00:17:18,320 --> 00:17:20,800 particularly if they have a complex problem like long COVID 262 00:17:20,800 --> 00:17:28,080 that doesn't necessarily fit yet with medical dogma a contested 263 00:17:28,080 --> 00:17:28,400 area. 264 00:17:28,400 --> 00:17:33,520 Yeah no question and if you look at the level of knowledge of 265 00:17:33,520 --> 00:17:36,320 many ordinary people about the nature of airborne transmission 266 00:17:36,320 --> 00:17:40,160 of not just COVID but other respiratory infections now it's 267 00:17:40,160 --> 00:17:45,200 way higher than that in the medical profession and there's 268 00:17:45,200 --> 00:17:47,760 an enormous problem which we've seen in the pandemic with 269 00:17:47,760 --> 00:17:53,200 knowledge translation in other words the latest knowledge and 270 00:17:53,200 --> 00:17:56,560 understanding being translated into everyday medical practice 271 00:17:56,560 --> 00:18:00,960 we've known that's a problem for years but we see you know it 272 00:18:00,960 --> 00:18:06,400 can take 10, 15, 20 years sometimes never for relevant 273 00:18:06,400 --> 00:18:09,280 information to get into medical practice and now with the 274 00:18:09,280 --> 00:18:12,640 availability of information with people able to Google able to 275 00:18:12,640 --> 00:18:18,000 see on Twitter what the latest studies are that contrast 276 00:18:18,560 --> 00:18:23,280 between what is known and what is being practiced is ever more 277 00:18:23,280 --> 00:18:28,560 dramatic and I mean just on a personal level my dad just to 278 00:18:28,560 --> 00:18:33,600 show how difficult this is my dad many years ago about 20 279 00:18:33,600 --> 00:18:42,400 years ago now he was in his early 80s he developed he got 280 00:18:42,400 --> 00:18:46,560 flu he got he then got a septic arthritis of his knee he had a 281 00:18:46,560 --> 00:18:50,560 staff arthritis of his knee was admitted to hospital perfectly 282 00:18:50,560 --> 00:18:56,320 correctly was started on high dose IV antibiotics flu 283 00:18:56,320 --> 00:18:59,840 floxacillin he then went into renal failure this was in the 284 00:18:59,840 --> 00:19:04,960 UK he was in his early 80s he was okay he wasn't in the best 285 00:19:04,960 --> 00:19:09,040 early 80 year old but he was wasn't bad and the doctor said 286 00:19:09,040 --> 00:19:12,560 in the hospital they knew they all knew me I was low for GP 287 00:19:12,560 --> 00:19:16,320 they all said well poor old boy his time's up and I said his 288 00:19:16,320 --> 00:19:19,520 time isn't fucking well up because he's got interstitial 289 00:19:19,520 --> 00:19:23,520 nephritis from the flu floxacillin that he's just had 290 00:19:23,520 --> 00:19:26,720 and he needs high dose he needs renal biopsy and he needs high 291 00:19:26,720 --> 00:19:31,200 dose steroids and then it will get better and they said no well 292 00:19:31,200 --> 00:19:34,320 we'd have to transfer him to the regional unit you know it's 293 00:19:34,320 --> 00:19:37,360 not really appropriate blah blah blah so I insisted so sure 294 00:19:37,360 --> 00:19:42,000 enough what happens he's got interstitial nephritis from the 295 00:19:42,000 --> 00:19:46,960 antibiotics he goes on to high dose steroids he gets better he 296 00:19:46,960 --> 00:19:52,400 lives another five years so now I had very specialist 297 00:19:52,400 --> 00:19:55,840 knowledge there and was able to insist and was prepared to 298 00:19:55,840 --> 00:20:00,240 insist so I do think it's important for people to be well 299 00:20:00,240 --> 00:20:06,080 informed and to approach with a degree of healthy and polite 300 00:20:06,080 --> 00:20:12,000 skepticism you know when when when doctors roll their eyes 301 00:20:12,000 --> 00:20:15,360 about the patient coming in with printouts from Google and 302 00:20:15,360 --> 00:20:18,240 they go oh Dr Google you know actually that's great you've got 303 00:20:18,240 --> 00:20:20,800 an engaged person you've got somebody who understands what's 304 00:20:20,800 --> 00:20:24,880 going on who wants to understand about their illness and who can 305 00:20:24,880 --> 00:20:27,520 be a good partner in that you know you can be a good partner 306 00:20:27,520 --> 00:20:31,440 to them in that journey I think we're much too defensive and I 307 00:20:31,440 --> 00:20:34,720 think we have to be much more open to people part of the 308 00:20:34,720 --> 00:20:38,960 challenge is finding the voices that you trust and my view has 309 00:20:38,960 --> 00:20:43,520 been that the voices to trust other humanitarians it's the 310 00:20:43,520 --> 00:20:46,800 ones who actually you know are trying to look after people 311 00:20:46,800 --> 00:20:50,240 rather than necessarily sell them something and there's 312 00:20:50,240 --> 00:20:54,080 there's no shortage of doctors out there trying to sell things 313 00:20:54,080 --> 00:20:58,320 but how did you find who to listen to during the pandemic I 314 00:20:58,320 --> 00:21:05,040 mean you've become a famous some might say infamous social 315 00:21:05,040 --> 00:21:10,960 media scion now what are we talking upwards of 316 00:21:10,960 --> 00:21:17,680 50,000 yeah hang off your tweets occasionally and yeah you 317 00:21:17,680 --> 00:21:21,760 you have good presence and you've also become known to the 318 00:21:21,760 --> 00:21:25,520 to the wider stream media as a result how did you find what 319 00:21:25,520 --> 00:21:29,840 people to listen to at the start of all this 320 00:21:30,720 --> 00:21:35,120 um I mean that's a really interesting question 321 00:21:35,120 --> 00:21:43,520 uh I I don't I I I've certainly developed a very good 322 00:21:43,520 --> 00:21:50,000 bullsh nose for bullshit over the years um and there is uh 323 00:21:52,800 --> 00:22:00,160 I think it comes down to as you said those who are 324 00:22:00,160 --> 00:22:09,520 humanitarian who speak plainly and who cite uh both evidence 325 00:22:09,520 --> 00:22:17,040 and reason it does seem to me that there is I mean there is 326 00:22:17,040 --> 00:22:20,640 a knowable reality some things are more true than other 327 00:22:20,640 --> 00:22:28,880 things um and people who make reasoned deductions on the 328 00:22:28,880 --> 00:22:34,880 basis of both evidence and scientific thinking where the 329 00:22:34,880 --> 00:22:40,000 evidence is lacking and rationality underlying a 330 00:22:40,000 --> 00:22:46,320 humanitarian uh with an underlying humanitarian voice 331 00:22:46,320 --> 00:22:51,600 it seems to me those people relatively quickly uh show 332 00:22:51,600 --> 00:22:56,720 themselves to be trustworthy um now by contrast you have like 333 00:22:56,720 --> 00:23:01,520 the people who say well you know the shadow pandemic uh 334 00:23:01,520 --> 00:23:08,800 lockdowns caused all this trauma uh and uh all this you 335 00:23:08,800 --> 00:23:11,840 know immunity debt and so we're seeing enormous 336 00:23:11,840 --> 00:23:15,600 consequences of this uh over the years and they will 337 00:23:15,600 --> 00:23:20,400 evince humanitarian uh aspirations and humanitarian 338 00:23:20,400 --> 00:23:23,200 ideals and they say well we're just looking out for the wider 339 00:23:23,200 --> 00:23:27,120 people but actually there's nothing underlying in terms of 340 00:23:27,120 --> 00:23:33,360 evidence in terms of rationale uh so those voices are false 341 00:23:33,360 --> 00:23:38,240 those who say you know we're concerned about studies that 342 00:23:38,240 --> 00:23:42,560 show a 36 times incidence in pulmonary embolus in the two 343 00:23:42,560 --> 00:23:46,720 weeks after contracting covid or we're looking at an excess 344 00:23:46,720 --> 00:23:53,680 death rate of 13 percent uh those uh seem to me much more 345 00:23:53,680 --> 00:24:00,000 trustworthy so i think it is it is a process um uh but you're 346 00:24:00,000 --> 00:24:05,200 right i mean it we have been brought up to believe that 347 00:24:05,200 --> 00:24:10,000 people who are professors and have lots of letters after 348 00:24:10,000 --> 00:24:13,760 their name are the people to trust and of course the people 349 00:24:13,760 --> 00:24:16,560 who are professors with lots of letters after their name 350 00:24:16,560 --> 00:24:22,240 also push that uh notion and we would like to think that 351 00:24:22,240 --> 00:24:26,080 everybody who is in the academic sphere in the medical 352 00:24:26,080 --> 00:24:29,920 sphere in the scientific sphere is good and has noble 353 00:24:29,920 --> 00:24:35,040 aspirations and noble ideals uh and a conscience as pure as 354 00:24:35,040 --> 00:24:39,600 driven snow uh but the reality as we've discussed before is 355 00:24:39,600 --> 00:24:45,840 that we are all human and i do not automatically trust 356 00:24:45,840 --> 00:24:50,880 somebody with lots of qualifications because we all 357 00:24:50,880 --> 00:24:54,960 have agendas i think that's a that's easier for those of us 358 00:24:54,960 --> 00:24:59,520 who have dealt firstly in the clinical area because we know 359 00:24:59,520 --> 00:25:02,640 that i'm sorry to say this the professor isn't necessarily 360 00:25:02,640 --> 00:25:07,120 the best surgeon um the one who's i was going to say that i 361 00:25:07,120 --> 00:25:10,160 as there was a pancreatic surgeon when i when i there was 362 00:25:10,160 --> 00:25:13,120 a professor of biliary surgery when i trained and like 363 00:25:13,120 --> 00:25:16,800 everybody in the hospital went just don't go and see him just 364 00:25:16,800 --> 00:25:19,840 don't send any of your relatives to him and we all know 365 00:25:19,840 --> 00:25:22,480 that we all know those people it doesn't mean they're not the 366 00:25:22,480 --> 00:25:25,840 best surgeon because they are the professor but the but the 367 00:25:25,840 --> 00:25:29,360 converse is also true it's yes it would be more often than 368 00:25:29,360 --> 00:25:32,320 not that the person who hasn't devoted a large chunk of their 369 00:25:32,320 --> 00:25:36,400 time to academia but who has in fact spent most of their time 370 00:25:36,400 --> 00:25:40,880 operating whilst being aware of the literature living in the 371 00:25:40,880 --> 00:25:44,560 shadow of what's happening academically that's most likely 372 00:25:44,560 --> 00:25:47,680 the person i think it is it's really hard for the general 373 00:25:47,680 --> 00:25:54,880 public uh to detect who to listen to and who not to um but 374 00:25:54,880 --> 00:26:00,160 as i say you know there is some degree to which you have to go 375 00:26:00,160 --> 00:26:03,360 with your gut you know is this person does this person actually 376 00:26:03,360 --> 00:26:07,120 sound like a humanitarian are they making sense uh and is 377 00:26:07,120 --> 00:26:11,120 there some kind of scientific basis to uh to what they're 378 00:26:11,120 --> 00:26:16,400 saying um i think the reality is that the regulatory uh system 379 00:26:16,400 --> 00:26:24,080 cannot uh cannot guarantee that uh the people who uh are 380 00:26:24,080 --> 00:26:29,040 appearing as your talking heads on tv etc are actually 381 00:26:29,040 --> 00:26:33,520 telling you the best information and that's that's the reality you 382 00:26:33,520 --> 00:26:36,160 know we have bullshit in medicine and and we're just like 383 00:26:36,160 --> 00:26:39,360 any other we're like any other profession any other branch of 384 00:26:39,360 --> 00:26:42,720 humanity they're a bullshit artist and they're really good at 385 00:26:42,720 --> 00:26:47,440 it and you just have to try and sniff them out well one 386 00:26:47,440 --> 00:26:51,120 way unfortunately they're very beloved of they're very beloved 387 00:26:51,120 --> 00:26:55,680 of executive producers on some tv shows but well that's that's uh 388 00:26:55,680 --> 00:26:59,120 that's true but you one way of sniffing them out is to to see 389 00:26:59,120 --> 00:27:02,240 how many times they've been wrong or how many times they've 390 00:27:02,240 --> 00:27:05,920 asserted the wrong narrative yes even if they didn't yes didn't 391 00:27:05,920 --> 00:27:08,960 know that it was wrong and and i think so you want a doctor who's 392 00:27:08,960 --> 00:27:12,880 humanitarian you want someone who's cautious so in the face of an 393 00:27:12,880 --> 00:27:16,080 emerging risk not someone who's saying don't worry about all this it'll be fine 394 00:27:16,080 --> 00:27:19,760 it's all a bit of a fuss when then we get 20 excess mortality and 395 00:27:19,760 --> 00:27:24,240 then they go and try and deny that at the same time but uh you know that 396 00:27:24,240 --> 00:27:28,400 is it that is an unlock blame it on lockdowns in south australia which had 397 00:27:28,400 --> 00:27:32,400 like three three days of lockdowns or something i think wa was less 398 00:27:32,400 --> 00:27:36,480 you know yeah exactly we had exactly and tasmania 399 00:27:36,480 --> 00:27:40,160 we had travel restrictions we could only go as far as karnanara and esperance so 400 00:27:40,160 --> 00:27:42,320 there was there was a lot of people in school 401 00:27:42,320 --> 00:27:45,680 parts of western australia they'd never seen before but certainly there was no 402 00:27:45,680 --> 00:27:49,040 uh there was no degree of lockdown and that's a whole 403 00:27:49,040 --> 00:27:51,520 another question that we'll approach another time 404 00:27:51,520 --> 00:27:58,000 but but yeah i did want to ask you um uh where you are at the moment and uh 405 00:27:58,000 --> 00:28:03,840 because you you have a peripatetic um kind of uh i i sometimes think of you as 406 00:28:03,840 --> 00:28:08,240 philius fog from um around around the world in 80 days 407 00:28:08,240 --> 00:28:12,960 just uh yeah it's been to be around the world so where are you at the moment 408 00:28:12,960 --> 00:28:18,880 so at the moment i'm on the uh north new south wales coast on the mid-north 409 00:28:18,880 --> 00:28:21,520 coast and sort of hippie near the hippie town of 410 00:28:21,520 --> 00:28:27,280 bellingham which was where we first moved when we came to australia 411 00:28:27,280 --> 00:28:30,560 but we pretty soon decided that we didn't 412 00:28:30,560 --> 00:28:34,320 want to that we wanted to do this is my wife's also a doctor's 413 00:28:34,320 --> 00:28:38,160 gp like me uh that we wanted to do more interesting medicine 414 00:28:38,160 --> 00:28:41,520 than being in a suburban general practice so 415 00:28:41,520 --> 00:28:44,640 we since we arrived actually in australia 416 00:28:44,640 --> 00:28:48,240 just over 10 years ago we've been working at the hospital in broome 417 00:28:48,240 --> 00:28:52,800 working in the emergency department on the ward and in the high dependency unit 418 00:28:52,800 --> 00:28:56,160 now that's not just down the road from where you are at the moment though 419 00:28:56,160 --> 00:29:01,200 no no it's a long it's about as far as you can get on the other side of 420 00:29:01,200 --> 00:29:04,560 australia so uh so we've actually just driven back 421 00:29:04,560 --> 00:29:09,760 uh in a in a land cruiser we came back it took us 10 days of hard driving we 422 00:29:09,760 --> 00:29:14,320 came back mainly on dirt roads from uh from broome which was good 423 00:29:14,320 --> 00:29:17,920 you took a shot spent about half a year we took a shortcut across the middle 424 00:29:17,920 --> 00:29:21,360 which is a bit of a long car long cut we didn't see another car for three 425 00:29:21,360 --> 00:29:26,080 days so this is an amazing country here so uh uh yeah we spent about 426 00:29:26,080 --> 00:29:28,960 half the year up there working in the emergency department which is 427 00:29:28,960 --> 00:29:35,600 uh about as challenging in so many different ways 428 00:29:35,600 --> 00:29:38,800 uh as i imagine medicine can be anywhere 429 00:29:38,800 --> 00:29:43,520 so really interesting work uh very heartbreaking sometimes 430 00:29:43,520 --> 00:29:49,200 uh and really rubs you up against the uh question of uh of of treating 431 00:29:49,200 --> 00:29:52,320 downstream results as opposed to upstream causes we're 432 00:29:52,320 --> 00:29:57,440 totally downstream and uh medicine needs to be upstream 433 00:29:57,440 --> 00:30:01,040 or at least a lot of it needs to be upstream 434 00:30:01,040 --> 00:30:05,600 so you're suggesting that prevention is better than cure 435 00:30:05,600 --> 00:30:09,680 horrors yeah the best quote the best quote 436 00:30:09,680 --> 00:30:13,200 is which i have which i've just been repeating all the time from archbishop 437 00:30:13,200 --> 00:30:15,920 desmond tutu he probably got it from somebody else 438 00:30:15,920 --> 00:30:19,040 so he said there comes a point where you have to stop 439 00:30:19,040 --> 00:30:23,280 fishing bodies out of the river down at the river mouth and go upstream to see 440 00:30:23,280 --> 00:30:26,640 who's kicking them in you know and we're just fishing the 441 00:30:26,640 --> 00:30:33,360 bodies out of the bottom of the river upstream prevention it's a bit dull 442 00:30:33,360 --> 00:30:37,280 because nobody gets ill and then people go well maybe he's ill so why do we need 443 00:30:37,280 --> 00:30:41,600 to do all this stuff uh but that's really where the big gains 444 00:30:41,600 --> 00:30:45,680 are to be made it's not in you know trying to get the hba1c 445 00:30:45,680 --> 00:30:50,480 down by another 0.5 percent by adding in another diabetic drug into 446 00:30:50,480 --> 00:30:52,800 somebody who's got a body mass index of 50 447 00:30:52,800 --> 00:30:59,440 you know that's that has a degree of futility about it that's 448 00:30:59,440 --> 00:31:07,120 yes so um do you find that uh you are able to sustain this sort of 449 00:31:07,120 --> 00:31:12,640 by this lifestyle of spending six months immersed into that 450 00:31:12,640 --> 00:31:16,880 emergency department because you can then uh 451 00:31:16,880 --> 00:31:22,960 spend a bit of time outside of that and do you think it balances with the 452 00:31:22,960 --> 00:31:26,560 advocacy work that you do trying to improve the upstream or 453 00:31:26,560 --> 00:31:33,920 or are they both incredibly taxing uh well i i i couldn't just do the 454 00:31:33,920 --> 00:31:37,680 that work probably 75 80 percent of our patients are 455 00:31:37,680 --> 00:31:42,240 indigenous aboriginal australians uh and seeing 456 00:31:42,240 --> 00:31:46,720 dealing with that on a day-to-day basis relentlessly 457 00:31:46,720 --> 00:31:54,000 uh is uh uh results in a very high degree of moral injury 458 00:31:54,000 --> 00:31:58,320 to health care workers it's very hard to do that work and not get burnt out 459 00:31:58,320 --> 00:32:02,800 uh so does it make you does it make you angry 460 00:32:02,800 --> 00:32:08,640 it it really makes me angry about you know the false promise of medicine 461 00:32:08,640 --> 00:32:12,160 medicine is so the medicine that we have today is 462 00:32:12,160 --> 00:32:16,560 so powerful and so incredible and we are seduced by it 463 00:32:16,560 --> 00:32:20,880 i mean as humans as hunter gatherers we are tool makers 464 00:32:20,880 --> 00:32:24,400 you know the history of our species the history of 465 00:32:24,400 --> 00:32:28,480 of the genus homo since a million years is a 466 00:32:28,480 --> 00:32:32,560 refined tool making the history of our species as homo sapiens over the last 467 00:32:32,560 --> 00:32:37,440 200 000 years is refined tool making and and an increased 468 00:32:37,440 --> 00:32:40,160 communication and the ability to cooperate to make 469 00:32:40,160 --> 00:32:45,280 amazing tools and our drugs are the most amazing tools and we are so seduced by 470 00:32:45,280 --> 00:32:50,480 them but in fact you know we we 471 00:32:50,480 --> 00:32:54,720 we do so much that is self-defeating we create 472 00:32:54,720 --> 00:32:59,040 the illness that we then go on to treat in this kind of virtuous loop 473 00:32:59,040 --> 00:33:07,280 or non-virtuous loop um uh and that's that's what makes me angry is the 474 00:33:07,280 --> 00:33:12,800 futility of what we find ourselves forced to do 475 00:33:12,800 --> 00:33:17,120 people don't mind working very hard but they they do not like doing work that 476 00:33:17,120 --> 00:33:21,280 is futile no exactly exactly and you just look at 477 00:33:21,280 --> 00:33:23,600 you go 478 00:33:23,840 --> 00:33:27,120 i can put a sticking plaster on this today 479 00:33:27,120 --> 00:33:32,160 but the damage was done so long ago um but so but you have to do it right 480 00:33:32,160 --> 00:33:34,640 someone has to be there for that of course you do 481 00:33:34,640 --> 00:33:38,400 yeah absolutely and that's the that's the beauty of medicine 482 00:33:38,400 --> 00:33:42,640 you know that you're there you've got the patient in front of you 483 00:33:42,640 --> 00:33:45,760 you have this very clear moral duty to do your 484 00:33:45,760 --> 00:33:49,840 absolute best to help that person in the best way possible for them 485 00:33:49,840 --> 00:33:53,120 taking into account everything blah blah blah uh so that's 486 00:33:53,120 --> 00:33:57,280 that's easy so actually standing there on the day 487 00:33:57,280 --> 00:34:01,120 you know you don't give somebody a lecture on the uh you know the importance 488 00:34:01,120 --> 00:34:05,120 of avoiding ultra-processed food and not drinking four liters of coca day 489 00:34:05,120 --> 00:34:08,240 etc you just got to treat their mi or whatever 490 00:34:08,240 --> 00:34:13,920 so that's easy um but it does there is an accumulated 491 00:34:13,920 --> 00:34:18,960 moral injury from that over time and i don't think i could do that 492 00:34:18,960 --> 00:34:26,080 uh every every week of the year without getting extremely burnt out so 493 00:34:26,080 --> 00:34:29,280 advocating so i'm just on for my personal 494 00:34:29,280 --> 00:34:35,440 well-being advocating for humanitarian uh uh aspects is very important i spend a 495 00:34:35,440 --> 00:34:38,720 long time advocating for a better treatment of 496 00:34:38,720 --> 00:34:43,600 refugees uh coming to australia um and uh as you 497 00:34:43,600 --> 00:34:46,480 know more recent against uh health care 498 00:34:46,480 --> 00:34:50,000 corruption particularly in the world medical association 499 00:34:50,000 --> 00:34:53,440 um and now as you know i've been a vocal proponent 500 00:34:53,440 --> 00:34:58,560 of safety in the pandemic for all of us but most especially those 501 00:34:58,560 --> 00:35:04,640 who are most vulnerable who have no uh who are so much more at risk and who i 502 00:35:04,640 --> 00:35:08,960 think have been grotesquely introduced uh during the 503 00:35:08,960 --> 00:35:14,960 pro during the pandemic and and are now being exposed to unacceptable risks 504 00:35:14,960 --> 00:35:19,120 in our health care system and that that's what makes me most upset and most 505 00:35:19,120 --> 00:35:23,600 angry uh is that we are no longer uh even 506 00:35:23,600 --> 00:35:28,400 paying lip service to first do no harm we don't care 507 00:35:28,400 --> 00:35:35,760 um it seems you have these two all us sort of um 508 00:35:35,760 --> 00:35:39,760 activities that you throw yourself into and one of them 509 00:35:39,760 --> 00:35:43,120 in a way cures you of the other and the other 510 00:35:43,120 --> 00:35:47,520 it does you spend your time in the emergency department putting the band-aids 511 00:35:47,520 --> 00:35:50,080 on because you know what to do for that person 512 00:35:50,080 --> 00:35:52,640 right in front of you and there is a real 513 00:35:52,640 --> 00:35:59,600 satisfaction in the immediacy of dealing with your father's interstitial nephritis 514 00:35:59,600 --> 00:36:03,680 and fixing a problem that is fixed in medicine like in politics like in law 515 00:36:03,680 --> 00:36:07,440 like in everything we want a problem that's fixable so that we can 516 00:36:07,440 --> 00:36:13,920 have a victory exactly there is it yeah i mean look it's fun you know it's it's a 517 00:36:13,920 --> 00:36:16,480 really interesting i mean i i partly i went into 518 00:36:16,480 --> 00:36:19,040 medicine because i absolutely love medicine i mean it's absolutely 519 00:36:19,040 --> 00:36:26,560 fascinating uh and the power the sheer power of what we can do is incredible 520 00:36:26,560 --> 00:36:30,880 i do think uh i mean here comes a bit where i i kind of lament about the young 521 00:36:30,880 --> 00:36:34,640 doctors of today but the young doctors of today i'm not 522 00:36:34,640 --> 00:36:38,960 even that old but they don't understand how things have 523 00:36:38,960 --> 00:36:44,640 changed even in 30 35 years hiv has become a chronic 524 00:36:44,640 --> 00:36:48,400 manageable condition i mean these are incredible things and 525 00:36:48,400 --> 00:36:51,760 so when you do something when you you make a great diagnosis you manage to 526 00:36:51,760 --> 00:36:56,000 cure somebody you put in a chest drain you know to relieve a pneumothorax 527 00:36:56,000 --> 00:36:59,040 whatever these are all incredible things to be able to do and there's some 528 00:36:59,040 --> 00:37:02,480 sometimes in the emergency department where we're going yeah we are the 529 00:37:02,480 --> 00:37:07,200 champions we figured it out yeah and so that's that's really you know 530 00:37:07,200 --> 00:37:12,000 that's really fun i mean it's of course we need that medicine 531 00:37:12,000 --> 00:37:17,600 the fact is a lot of it we shouldn't have to be doing i mean we'll always 532 00:37:17,600 --> 00:37:22,000 have to do some of it but so much of it is like we don't have to be 533 00:37:22,000 --> 00:37:25,600 doing this so you're like a firefighter who gets a 534 00:37:25,600 --> 00:37:29,200 real satisfaction out of putting out a fire but every now and then you kind of 535 00:37:29,200 --> 00:37:33,040 want to make a fuss about why don't we have better fire safety why are we 536 00:37:33,040 --> 00:37:36,880 getting so many damn fires because who's who's making and the fact that there are 537 00:37:36,880 --> 00:37:39,520 some people making money out of this and there are other people wandering 538 00:37:39,520 --> 00:37:43,200 around going exactly don't worry about all the fires don't listen to Berger you 539 00:37:43,200 --> 00:37:46,160 know he's trying to impinge on your freedom by saying that you need to have 540 00:37:46,160 --> 00:37:52,640 a fire extinguisher exactly and yeah exactly it's ridiculous to advocate for 541 00:37:52,640 --> 00:37:57,920 zero fires what a ridiculous idea you know it's bizarre but it's so weird 542 00:37:57,920 --> 00:38:03,920 isn't it the way you know we can advocate you know that we 543 00:38:03,920 --> 00:38:07,760 have this manifest these manifest targets for like zero road deaths which 544 00:38:07,760 --> 00:38:10,720 is totally unrealistic i mean they'll never be zero road deaths 545 00:38:10,720 --> 00:38:14,240 but but the government's spent billions trying to get to it 546 00:38:14,240 --> 00:38:19,040 presumably partly because that you know there's a lot of money in its motor 547 00:38:19,040 --> 00:38:22,480 manufacturers to build safer and safer cars so there's this kind of 548 00:38:22,480 --> 00:38:28,240 coincidence of of aspirations but in other things it you know there 549 00:38:28,240 --> 00:38:32,720 really isn't any there really isn't any interest so 550 00:38:32,720 --> 00:38:36,320 like the notion that we should have zero hospital acquired 551 00:38:36,320 --> 00:38:39,680 respiratory infections for instance that we should make our hospitals safe if 552 00:38:39,680 --> 00:38:42,880 people go well that's just ridiculous you know we can't 553 00:38:42,880 --> 00:38:48,960 we can't even what an absurd aspiration and yet the history of humanity 554 00:38:48,960 --> 00:38:55,760 is that we are cunning clever fiendish and we accomplish 555 00:38:55,760 --> 00:38:59,760 everything we do the most amazing things and yet the simplest things if 556 00:38:59,760 --> 00:39:04,720 they're not politically expedient we are indoctrinated to believe that 557 00:39:04,720 --> 00:39:10,160 they are impossible and that's where i'm most upset 558 00:39:10,160 --> 00:39:13,360 about what i see is the failure of leadership 559 00:39:13,360 --> 00:39:16,400 in the medical profession that the medical profession should not be doing 560 00:39:16,400 --> 00:39:18,560 the bidding of the pharmaceutical companies 561 00:39:18,560 --> 00:39:22,960 or a government whose only short term our main short-term aim 562 00:39:22,960 --> 00:39:28,720 is to get people back into city center business properties cvd business 563 00:39:28,720 --> 00:39:32,080 properties and to get coffee shops running again 564 00:39:32,080 --> 00:39:36,640 at full capacity that's what really annoys me 565 00:39:36,640 --> 00:39:41,360 when our privilege gets revealed to us we then have these constant moral 566 00:39:41,360 --> 00:39:45,040 judgments to make about how much do we go down into the abyss and look into the 567 00:39:45,040 --> 00:39:48,000 abyss trying to help because you can give away all your wealth tomorrow 568 00:39:48,000 --> 00:39:52,640 walking through the streets of africa and make no difference at all and on a 569 00:39:52,640 --> 00:39:56,560 substantial sense whatever how much life are you entitled to reserve 570 00:39:56,560 --> 00:40:01,920 to yourself to enjoy do you think it's possible to to have a 571 00:40:01,920 --> 00:40:04,880 balance where you're not beating yourself up too much you're not getting 572 00:40:04,880 --> 00:40:07,280 in too much trouble you're still doing your job 573 00:40:07,280 --> 00:40:11,360 but you're actually making some sort of progress or is this as 574 00:40:11,360 --> 00:40:16,000 people like falcon might suggest a long defeat where we're just seeing sort of 575 00:40:16,000 --> 00:40:19,840 some some nice pushback occasionally but in the end things sort of get tending 576 00:40:19,840 --> 00:40:24,800 towards entropy yeah i mean i think that things obviously 577 00:40:24,800 --> 00:40:28,320 you know all the nature of entropy is that everything tends tends towards the 578 00:40:28,320 --> 00:40:31,840 less ordered state and that is the nature of the universe 579 00:40:31,840 --> 00:40:38,800 but and life and particularly humanity we are the entropy reversing 580 00:40:38,800 --> 00:40:44,160 process particularly you know we reverse entropy 581 00:40:44,160 --> 00:40:48,000 on this local scale we per capita command more and more 582 00:40:48,000 --> 00:40:52,160 energy we control more and more of the solar energy that's reaching the planet 583 00:40:52,160 --> 00:40:56,960 i do think that one can get terribly bound up with this kind of 584 00:40:56,960 --> 00:41:00,720 obsession with purity of motive you know how pure am i am i doing enough should 585 00:41:00,720 --> 00:41:04,240 i be doing more etc and i used to get very tortured by that 586 00:41:04,240 --> 00:41:08,560 you know this kind of absolutist 587 00:41:08,560 --> 00:41:13,440 view of things and i think it's a very western way of looking at things 588 00:41:13,440 --> 00:41:16,720 i mean i i you know i think you just do what you can 589 00:41:16,720 --> 00:41:19,600 you just try not to be a shit in your personal life 590 00:41:19,600 --> 00:41:26,960 and you try to work the best you can for others given the limitations that you 591 00:41:26,960 --> 00:41:32,320 have and none of us are perfect and i don't yeah personally i don't 592 00:41:32,320 --> 00:41:34,800 feel the need to kind of strive for protect 593 00:41:34,800 --> 00:41:38,800 perfection which is a good thing because i'm so far off it 594 00:41:38,800 --> 00:41:45,600 but i think i think i think just understanding that that the quest for 595 00:41:45,600 --> 00:41:51,280 purity of motive is a quest but you don't necessarily have to 596 00:41:51,280 --> 00:41:54,560 follow it you can just try and do the best you can and it's 597 00:41:54,560 --> 00:41:59,040 better than not doing the best you can and it's okay to make a holiday from it 598 00:41:59,040 --> 00:42:03,200 and enjoy yourself exactly because you're only human and you 599 00:42:03,200 --> 00:42:07,120 there's only so much you can do and beating yourself up is it's another 600 00:42:07,120 --> 00:42:11,040 kind of vanity in a way you know it's like you know i should be so 601 00:42:11,040 --> 00:42:15,680 perfect i could be doing this and it's just like come on just listen 602 00:42:15,680 --> 00:42:18,800 yeah i think that's been a good orientation 603 00:42:18,800 --> 00:42:24,160 uh to my provocative uh question is what's the point of you 604 00:42:24,160 --> 00:42:28,720 um i think i'm gonna have to interview you and i'll see what's the point of you 605 00:42:28,720 --> 00:42:33,280 no no that's not the premise that's a very interesting question as well 606 00:42:33,280 --> 00:42:36,800 it's nothing it's not the i'm not ready for that question maybe when i get to 607 00:42:36,800 --> 00:42:40,320 your your esteemed seniority then i'll then i'll be ready 608 00:42:40,320 --> 00:42:44,240 of course uh if we do anything by sharing these chats 609 00:42:44,240 --> 00:42:47,680 i want people to not feel alone because there are people who don't have our 610 00:42:47,680 --> 00:42:50,240 privilege of having a pretty still a pretty reasonable 611 00:42:50,240 --> 00:42:55,360 immune system being able to get out yeah and people who find it difficult to 612 00:42:55,360 --> 00:42:58,480 access their health care at the moment there are people who have split up from 613 00:42:58,480 --> 00:43:02,640 their families at the moment because there's no understanding about 614 00:43:02,640 --> 00:43:07,280 what it is they're going through so if in having these chats people can 615 00:43:07,280 --> 00:43:11,040 uh understand that there are those who have 616 00:43:11,040 --> 00:43:14,560 not just sympathy for them but also strategy also connection 617 00:43:14,560 --> 00:43:19,920 also potentially some influence uh on on the way people think about things if 618 00:43:19,920 --> 00:43:25,120 not explicitly then maybe um we we influence the way that people 619 00:43:25,120 --> 00:43:30,080 um thought leaders or decision makers do think 620 00:43:30,080 --> 00:43:34,080 even though they might never want to admit it then i suspect we can repeat 621 00:43:34,080 --> 00:43:38,560 the same conversation next time and just say it in a slightly different way 622 00:43:38,560 --> 00:43:53,440 perfect 623 00:43:53,440 --> 00:44:15,680 I'm back here again, I told myself I'd stay a while away 624 00:44:15,680 --> 00:44:19,520 Solutions ahead but don't carry on 625 00:44:19,520 --> 00:44:32,000 Blinded by nothing, we'll wait through it all 626 00:44:32,000 --> 00:44:36,240 Hold on to the dark 627 00:44:36,240 --> 00:44:39,200 There's a grace in the fire and the flames 628 00:44:39,200 --> 00:44:43,280 Thoughts drifted so far 629 00:44:43,280 --> 00:44:46,480 In this room I've lost my way 630 00:44:46,480 --> 00:44:51,280 All trees are clad 631 00:44:51,280 --> 00:45:00,400 So far below me now 632 00:45:00,400 --> 00:45:03,760 And where do I go when the signs aren't so bright 633 00:45:03,760 --> 00:45:08,000 And I'm weighed down by feeling I don't have much time 634 00:45:08,000 --> 00:45:12,000 It's okay, I suppose, let's just hope that it goes 635 00:45:12,000 --> 00:45:16,720 No need to stress over a failure to cope 636 00:45:16,720 --> 00:45:35,680 I'll take my anguish and go