Inspiring Doctors - profile #35
February 2019
Dr Clare Alice Skinner
BSc ANU 1995
BA (Hons) ANU 1996
MBBS Sydney 2001
MPH Sydney 2004
FACEM 2011
Specialty:
Emergency Medicine (with lots of Medical Administration and Medical Education thrown in)
Current practice:
Director of Emergency Medicine, Hornsby Ku-ring-gai Hospital
Chair – Emergency Medicine Network, Northern Sydney Local Health District
ACEM – Council of Advocacy, Practice and Partnerships; NSW Faculty Executive; Diversity and Inclusion Steering Group; Health System Reform Committee; Mental Health Champion
Previously – Senior Lecturer in Medical Curriculum, University of Sydney
Childhood aspirations?
My dream job has always been something along the lines of literary critic and chocolate taste-tester – combining my two favourite activities. Sadly, no career opportunities like that have ever presented themselves. Maybe later?
At about age seven, I announced to my family that I wanted to be a poet. And I still do, and still hope I am, a little bit, somewhere deep inside. But – that didn’t really lead anywhere, although there are some very embarrassing writings hiding in a box under my house. And in letters sent to friends, which I hope they have destroyed.
I tossed up a few options at school. I was absolutely fascinated by the unfolding story of HIV/AIDS, so medical research was on the agenda, and I did work experience in the Immunology Department of Royal Prince Alfred Hospital in Year 11 – hanging out in clinic during AZT trials was an eye-opener, an invaluable lesson in human behaviour (patients were sharing their meds to avoid placebo), and a massive privilege I have never forgotten. I also really wanted to write and had vague notions of having a column in a newspaper and being on panel shows to talk about ideas. I thought I might do this with a health or science bent – so spent a few days hanging out with Karl Kruszelnicki and did some volunteer work on the production team of Beyond 2000. My third option was professional music – but I made the (wise) decision that I did not have the patience or discipline to turn music into a career, although it is only in the last few years that I have accepted that I will never do the diploma of jazz studies at the conservatorium – something I really hoped to achieve as a teenager.
Pathway to medicine?
I didn’t seriously entertain studying medicine straight out of school. I have a near photographic memory and am a keen observer of everything, but I get bored very easily and I’m not good at studying for studying’s sake. I didn’t do homework – instead I was expert at excuses and improvisation. I never thought medicine was within reach, so I didn’t strive for it. I prioritised other things, like playing the saxophone in a jazz club in California (owned by Dizzy Gillespie), and being interviewed by ABC radio while marching in support of NSW public schools, and arranging music for my choir which had a gig singing Advance Australia Fair at Government House. In the end I did pretty well in the HSC, despite being highly distracted, but not well enough to go to medical school.
In the spirit of keeping my options open, I enrolled in a combined degree in Arts and Science at the ANU in Canberra. I just love learning and squeezed as much as possible out of this fantastically broad course – history, english, philosophy, women’s studies, molecular biology, genetics, chemistry, maths, a fabulous theme called ‘science in context’, and a little bit of music thrown in too. I worked part-time for the Disability Support Unit, and in this capacity I scribed lectures in economics, environmental science, anthropology, geology, geography, political science, law, education and Asian studies. I did honours in history in 1996 – the year the ACT government proposed the heroin trial – and wrote a thesis about criminalisation of narcotics in the wake of World War I, which was an exploration into 1920s razor gangs and the birth of the modern pharmaceutical industry. My favourite discovery was a small brown paper package containing cocaine powder (I presume) which I found in an unassuming manila folder in the national archives, stapled to notes from a 1920s government inquiry into drugs of addiction. You’ll be glad to know I left it there.
I was now very interested in a career in public health, specifically drug and alcohol, and got talking to Peter Baume (the Chancellor – yes, I chat to everyone) after my BA graduation ceremony. He suggested that I study medicine and mentioned that Sydney University was just about to start a postgraduate medical course, and that planted a new idea into my head.
So – I applied for the Graduate Medical Program and, in the meantime, I sat the entrance exam for a newspaper journalism traineeship, sent an excrutiatingly awful video audition to the ABC, and applied for the Australian public service graduate program as a back-up plan. My hopes for medicine were not high after the GAMSAT exam – if all else fails, just choose ‘C’.
I joined the newspaper as a ‘copy boy’ in 1997. The job pushed all my buttons. I can honestly report that my experiences as a trainee in the media make hospital culture, in comparison, seem warm, friendly, open and supportive. I was working on the news desk during the Thredbo landslide and was asked to ring random numbers in Lake Tahoe USA to find neighbours and friends who might be willing to comment about the American couple (Mim and Mike Sodergren – I still remember their names) who were killed in the tragedy. It was 4am-ish California time and my calls were not going down well. I remember thinking that if this was journalism, I had no stomach for it – and that I would rather be a do-er than a commentator. When I was accepted into the GMP a few weeks later, the decision to leave was easy. Knowing that I was out of there, I negotiated penalties for after-hours work, access to toilet-breaks on night shift, and more transparency about promotion through the trainee program. I also wrote a very rude letter and snuck it on to the CEO’s desk on my last day. Ha!
In the months before the GMP started, I worked as a clerk at the Australian Industrial Relations Commission – lodging unfair dismissal claims and industrial disputes. I got to know all the union leaders, the court reporters, and was the person on the end of the phone at the start of the high-profile dispute between Patrick Stevedores and the Maritime Union – which was the major test of the Howard government’s industrial reforms. It was an interesting time to be there. I also gained valuable experience from interviewing people from all walks of life who had lost their jobs.
Pathway to your specialty?
I started medicine aiming to have an academic career in public health and never thought I would be a clinician at all – yet somehow I’ve fetched up doing something very clinical.
As a junior doctor at The Canberra Hospital, I enjoyed every term, and always looked forward to starting the next term to learn and do new things. I loved ED rotations in PGY1 and 2, but was put-off by shift work, and by the notion that there was too much to know to be truly expert. I had a wonderful mentor figure in Professor Frank Bowden and aimed to follow in his Infectious Diseases/Sexual health footsteps, so started Basic Physician Training. However, a couple of personal hurdles changed my path.
I had married my boyfriend from medical school in final year, and the marriage ended in Term 4 of intern year – less than a year after it began. The reasons for this are multifactorial and complex, and I won’t and can’t go into them here, but it was devastating and difficult. I found myself emotionally and intellectually adrift. Every major life decision I had made was now out-of-context and had to be made again – which was terrifying, but also enormously liberating.
In the middle of RMO year I lost my voice, which I ignored for months, until the ENT registrar pulled me aside, did a scope, and diagnosed vocal cord paralysis. During this time, I got aspiration pneumonia, became delirious, and was sent home from a shift after unplugging patients from their cardiac monitors (I thought I was defusing a nuclear submarine – the movie in the RMO lounge that night was ‘K-19 The Widowmaker’). I entered a world of diagnostic tests and procedures, and completely lost confidence in myself. I had surgery to insert a prosthetic cord the day before my thirtieth birthday and woke up feeling like I couldn’t breathe. I started my first job as a medical registrar two weeks post-op, completely physically run-down, and entirely emotionally burnt-out. I resigned four weeks later.
I took a month off, then started as 0.4 job-share medical registrar at another hospital. I enrolled in a Master of Public Health with a view to my original academic career path. I picked up locum shifts in ED to keep my critical care skills alive and dropped the medical registrar job when a policy position came up – investigating medical workforce issues. I also did regular medical student teaching for Sydney University – PBLs, communication skills, EBM and population health. At the end of the year I toyed with public health training, but I was really enjoying ED clinical work, so I took a provisional trainee position at Royal North Shore Hospital and joined the ACEM training program. It hasn’t always been easy, and I tried to abscond twice, but as an all-rounder who likes talking to people, teaching, and solving complex problems, I really do think it is the best specialty for me. I also feel that I have found my tribe in the amazingly hard-working, smart and creative ED doctors and nurses I work alongside, and who share my values.
What gives you joy in your life?
I find joy in ideas and relationships. I love clever concepts, complex systems, politics, theories, models and the big picture. I find hospitals endlessly fascinating. I read about how health systems function, workplace culture, and how human beings behave – for fun! I love meeting people, learning about them, and working out what makes them tick.
The best aspect of my job as ED director is mentoring and coaching junior doctors, looking after them, helping them find their niche, and watching them develop into more experienced and confident clinicians. I’m lucky, because I work with people who I truly love, so while I have no balance in my life whatsoever, it doesn’t matter that much, because there is so much pleasure and satisfaction for me in my work – and spending time with my work family.
I obviously also love my home family to pieces – my partner and my two children bring me so much pleasure, pride and happiness.
How do you look after your own wellbeing?
At work, I deliberately try to have and project a positive attitude. I choose to interpret other people’s actions through a lens of empathy, rather than anger or judgement. I try to understand people and get on with them. I make an effort to thank people and say positive things. I remember birthdays and bring flowers and cake. I let my colleagues know how much I appreciate them. I am mindful of how lucky and privileged I am at all times.
It might sound counter-intuitive, but the sense of agency I have from being in leadership roles deeply contributes to my wellbeing. It is enormously satisfying to be able to make real changes to help my team, my hospital and my specialty – and especially to know that I am doing my best to improve healthcare experiences for my patients and community.
At home, I try to spend quality time with my family. I take a chunk of proper time off during the school holidays each year to just be a normal mum. We laugh, cuddle, cook, read, dance, sing, paint, do jigsaw puzzles and go on road-trips. We have family and friends over to dinner constantly.
I regenerate through being creative. I play the piano all the time. I’m a member of the Doctors Orchestra. I write, I draw and I daydream. Not quite as much as I would like, but enough to stay in touch with the poet my seven year old self hoped I might become.
I’m not so good at diet and exercise. I eat way too much chocolate (guess how much and triple it), and I’m trying to go for a long walk by myself a few times each week, but it is tricky. This is something I have to work on.
What are you most proud of in your life?
I think I’m a good person. I have strong values and I live by them, and I am lucky to have enough in my tank to be able to support others. I feel proud when junior colleagues seek me out for advice or mentorship, and it makes my life better and richer too.
I’m good at making things happen. I know how to translate ideas into action.
I bounced back from a failed marriage very well – and that wasn’t easy.
I was chosen as one of the Top 50 Public Sector Women in NSW in 2018 – that’s pretty amazing! I’ve subsequently worked with Kim Hansen to establish the Advancing Women in Emergency section within ACEM and can’t wait to see where that leads.
AND – my two children are just fantastic. They are curious, clever, engaging and get on with people. Who could ask for more than that?
What makes you unique as a doctor?
I don’t kid myself that I’m unique! I try to be as ordinary as possible, and I think my winding path into medicine, including my very broad education, helps me relate to lots of people. I aim to always keep things human.
I do think I have a particular ability to remember what it was like to be a student, junior doctor, trainee and new consultant, and those memories help me support colleagues as they move through those stages.
I have felt the deep, horrible, gnawing desperation of burn-out and I talk about it.
If you could send a message back in time, what would you say to yourself ten years ago?
It’s okay to be yourself – life will just keep getting better. You’ve got a wonderful ten years ahead.
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