Sunday, September 30, 2012

Response From 2GB Advertiser

I have received one response from Harris Partners who were on the list of advertisers with 2GB.  It is pasted here immediately below.

On 30/09/2012, at 17:40, Harris Partners Info <> wrote:

In order to set the record straight, we do not advertise with Alan Jones. I am perplexed as to how or why Harris Partners Real Estate were added to the petition that is now doing the rounds.

Both my wife and I felt Alan Jones' "shame" comments in relation to Prime Minister Julia Gilliard's father John Gilliard passing away, were disgraceful and offensive.

Harris Partners does pay to advertise on Ross Greenwood's 2GB Money News programme from time to time. It is non-political and in line with our target audience.

Any Harris Partners ads that may have run during Alan Jones' programme were unpaid advertisements. Other than the complaint emails I received from telling me that we advertise on Alan Jones' programme, I was totally unaware that we were ever featured on Jones' show.

If you get the chance to forward this email to the person that associated us with Alan Jones and added us to the petition mail-out, I would be grateful.

Best wishes

Peter O'Malley

Harris Partners Real Estate
404 Darling Street
Balmain NSW 2041

Ph:  (02) 9818 2133
Fax: (02) 9810 6432

Here is my response back to that email:-

On 30/09/2012, at 9:30 PM, "Henry Woo"  wrote:
Thanks for your reply Peter. I am sorry to hear that you are having to respond to so many emails - nevertheless, it is decent and honorable that you do so. I have no idea who complied the list but I imagine that you are on there because of your current association with the 2GB station. Unfortunately, people see 2GB as being complicit to Alan Jones behavior and everybody associated with the station gets caught up in the mess. Your withdrawal of advertising from 2GB would send a strong message of where you stand on the matter and that as an advertiser you are sensitive to public opinion which affect your business. I will however do my bit to propagate your repulsion of his behavior by putting your response below on my blog although actions speak louder than words by your company reconsidering doing any business with 2GB until appropriate action is taken to rein the shock jock in. 
Best regards
Sent from my iPhone. Apologies for typos and autocorrect functions choosing wrong words. 

Here is the response back from my 2nd email:

From: Harris Partners Info <>
Date: Sunday, 30 September 2012 9:35 PM
To: Henry Woo
Subject: Re: Alan Jones 2GB

Thanks Henry.

We have had thousands of emails today.

Unbelievable day, the end is in sight :)



Sometimes It is Okay to Not to be Tolerant

Below is the email sent to the following email addresses. If you wish, you may cut and paste these addresses into your email programme. We cannot touch Alan Jones through the broadcasting regulator (his comments were off air) and his association with 2GB (financially and personally) make it unlikely he will be dismissed or reprimanded for damaging the 2GB brand.;;;;;;;;;;;;;

Dear Sir/Madam

I am writing to you as a sponsor and supporter of Alan Jones and 2GB. I am hoping that your company is sensitive to the opinion of the wider community beyond 2GB listeners. Over many years, the shock jock comments of Alan Jones have largely been tolerated. I personally have tried to see his positive aspects, particularly in his support of rural and remote communities and non-profit organisations. We have even allowed the issues with the alleged 'cash for comments' affair and his alleged dealings with London police to go to the keeper.

He sailed too close to the wind with his comments about women "destroying the joint" for which any reasonable person would regard as a misogynist comment. If women in leadership roles have been incompetent, it has nothing to do with gender but incompetence in that persons performance. Nothing more and nothing less and to suggest incompetence is gender related is out of step with modern community values. It was not surprising that this became a national trending discussion point on social media.

This latest outburst has taken things too far and confirms that he is out of step with community values. I consider it to have been totally un-Australian. I will not repeat the story behind this matter as you will already be well versed in the course of events as well as the dishonourable attempts to either cover up or massage the truth from what has already been reported in the media. The matter has absolutely nothing to with one's political persuasion and this occasion, the community has had enough and is clearly voicing its displeasure through social media and conventional channels. I believe that your continues support of 2GB implies your continued support of what he stands for. Calls for him to step down or to be censured by 2GB are futile as he is understood to have shareholder of 2GB and enjoys a long close friendship with those who control the station.

I feel sufficiently strongly about this matter that I write to you to appeal to you distance your company from Alan Jones and 2GB. Your failure to do so makes you complicit to his increasingly unacceptable behaviour. With your continued association with Alan Jones and 2GB, I intend to personally make every effort to use products and services of your competitors and would encourage others to do the same. To under-estimate the opinion and power of social media is at the peril of your organisation's community standing.

I sincerely hope that you will do the right thing.

Henry Woo

Thursday, September 27, 2012

Doctors Tweeting for Entertainment at the Expense of Public Confidence?

As health professionals participating in social media, we do come across things that we see as inappropriate for a member of our profession in terms of behaviour or content. The temptation is to leave all alone (and unwittingly be complicit to the bad behaviour) or to participate in the self regulation of the medium. SoMe has got a lot of bad press recently and as usual, it is always the tiny percentage of users who create the problems. Recently, Australian users have been concerned about the draft document of proposed regulation of SoMe amongst health professionals by our regulating body, APHRA. As it is, it is heavy handed and unchallenged into its final version would see a significant number of Australian healthcare professionals in breach of its conditions. This got me thinking about a recent interaction that I had virtually forgotten about. I saw a tweet from a young doctor who has chosen to be anonymous when tweeting to his large audience of followers. The tweet was as follows:-
I personally did not think much of it at first but then I thought that as a public message, it was sending out a very wrong message as to what really goes on in multi disciplinary team (MDT) meetings. The reasons clinicians bring cases for discussion at these meetings is to get the best advice from a wide range of opinions from within their own field and outside the field. Too often at these meetings, I find as a surgeon, that I have not always fully considered some of the surrounding non-surgical issues with the care of my patient and I can leave the meeting with a clearer holistic approach to the care of my patient. Patients are delighted to know that we can take their case for multiple opinions rather than themselves having to cart themselves around to see different doctors to obtain additional opinions. The MDTs also helps streamline the multidisciplinary care with colleagues will look out for special cases that cannot afford to be held up by the system. But MDTs do not always function well. The worst type is when there is the dominant clinician who loves discussion on a case as long as it is his or hers and if the final outcome is according to his or her recommendation. Less dominant or junior participants feel essentially gagged from making a contributing comment. The ideal MDT should run like a real-life in person crowdsourcing exercises. I responded to the MDT comment with
In hindsight, perhaps I was a little too harsh in suggesting that he might be ignorant about the value of MDT meetings but it is people's live that we deal with at these meetings and not something that I thought to be for entertainment purposes amongst his following. (If you follow this user, he does provide a predominantly entertainment series of tweets and thrives on the adulation of his audience). I was also concerned that he may have developed this attitude because his own MDT experience was not associated with appropriate leadership and mentoring in cancer care. I cannot see any reason why he would come up with this thought if there had been anything but a positive experience with MDTs. This tweet did upset him as seen by the next tweet:-
This lead to a series of tweets which are fairly self explanatory
My tweet response below is to a tweet that was subsequently deleted but since I did a quoted retweet to give context to my next statement, you are able to see what was deleted.
I think that his comment about being exposed to bad MDTs (that's the tweet that got deleted) demonstrates a problem of where he has been exposed to poor leadership and mentorship in cancer care. This is sad and senior cancer clinicians should take note.
I thought that things might get a bit heated so I tried to back off and give him an honourable exit by agreeing with him on a point and stating that I did not think that he meant to be flippant. When I thought about it later, I did change my mind and think that to hell yes he was being flippant.
I did not feel like challenging him on the fact that surgery is not the only form of treatment for cancer and opinions of other non-surgeon clinicians can make a difference. MDTs are not about 'personal', they are about the patient whose care we are trying to optimise. I was about to let it go and let him continue his indignation that he had been challenged but this fortunately put out the flames.
I promptly un-followed him. I think it is always a lot easier to say things anonymously but even under such cover, if you declare yourself as being a health professional, the public and your colleagues still have an expectation for a level of professionalism for what you represent. This is of course my humble opinion on the matter.

Addendum 31 March 2013

A doctor on twitter who had read this blog piece recently, sent me the following cropped mobile phone screenshot by email (easy to track down via either one of my publications or through the University of Sydney website - you see, I don't try to hide) that was taken of a tweet made about 10 days ago - comment was made that it was seen from a re-tweet as this person like myself, does not follow @otorhinolarydoc.  It wasn't sent to me anonymously but there is nothing to be gained by mentioning who that person was.  Interestingly, it is noted that he has since changed his user name and from this I gather that he is perhaps no longer a trainee and now a qualified ENT surgeon.  Whilst we can say it is a bit of harmless banter, it does concern me of possible attitudinal issues about morbidity and mortality meetings.  M & M is an essential form of quality control and good clinical unit governance and must be taken seriously.  Sadly it seems to be consistent with earlier comments about MDT meetings.  Whilst we could be quick to chastise this doctor who tweets anonymously, I would raise concerns about potential mentorship issues - registrars often copy the behaviour of their mentors - perhaps there is some shared responsibility between himself and his former mentors if these are the attitudes with which he has been raised as an ENT surgeon.  Let you be the judge on this.

Monday, September 24, 2012

Successful Crowdsourcing on Twitter

This weekend I was writing a manuscript that was due weeks ago. This involved researching what had already been published on the subject and through my academic appointment at the University of Sydney, I thought that I should be able to access any article in the urological field without any problems - I had good reason to think this since I had never had any problems previously. Then for the first time ever, I needed an article from the Canadian Journal of Urology. When I searched for the journal through the on line resources of the University of Sydney library, it wasn't there. I double checked that I did not get the name wrong and just searched 'Canadian Journal' and it seemed that every other specialty was covered except for the Canadian journal in the urology surgical specialty. It was Sunday and as usual, it was an article that I needed now and not tomorrow as I was keen to wrap up the section I was writing. I though that I would try putting out the problem to Twitter and to see what would happen.
It was fantastic to get such a quick response. Given the international make up of a Twitter audience, it was not surprising that my late night tweet was more likely to be picked up by my American colleagues. At first it seemed like this was going to be a difficult task as you can see from the responses. It was interesting that this got a retweet from somebody who does not even follow me - shows the potential amplifying effect of Twitter. Now this was the tweet that topped all the responses
It was like a call to arms for the true believers. At the end of it all, victory was achieved and the article was emailed to me.
To top off the mission, a final tweet as below
In spite of negative press about the ills of social media, this has been an excellent positive outcome with the use of social media in healthcare. Crowd sourcing can work well amongst health professionals. One could argue that I could have simply have emailed these guys - I didn't have their email addresses. The reason I used Twitter was for the fact that short messages are easy to digest and in my opinion a lot quicker to scroll through with absorption of the content than reams of emails and looking up/down the wall on Facebook and therefore more likely to catch the attention of my colleagues. I don't have a huge number of followers on Twitter but even with less than 200 followers, a beneficial outcome was able to be achieved. As the reach Twitter continues to expand amongst those in healthcare and education, I can only see its use in this manner increasing.

Sunday, August 12, 2012

A Hypothetical Introduction to Research

Trainee: Hi Prof, I am interested in doing a research project now that I have my final exams out of the way.
Prof: No problem. Why don't you go talk to Doctor who has been working on a personal series of interventions for the last 10 years and needs somebody to write it up.
Trainee: Thank you.

Trainee: Hi Doctor, Prof said that you had your intervention series that you were keen to write up.
Doctor: Perfect timing. It is now mature enough to be written up.

Yada yada yada between Trainee and Doctor and a few months pass.

Doctor: Great job with the data analysis. We are close to the write up. Lets get the first draft together.
Trainee: Great stuff.

Prof: I heard that Trainee has done a great job so far. We should work out authorship. Trainee can go first and you second and I'll be last and senior author.
Doctor: Whilst I appreciate your referrals, this is my personal series and labour of love that I have worked on for 10 years and I should be senior and corresponding author.
Prof: But I was the one who introduced Trainee to you so I should be. It was my idea to push you along with getting the intervention written up.
Doctor: I was planning to have it written up in any case.

Yada yada yada between Doctor and other departmental colleagues who agree that Trainee should be first author and Doctor the senior and corresponding author.

Phone rings.

Prof: I have a solution to this impasse
Doctor: Great, I have been concerned about the friction this is causing in the department.
Prof: This will solve the problem. Why don't you go first author and take the credit for your hard work over 10 years and I go last and corresponding author.
Doctor: But what about Trainee?

Trainee: WTF???

Trainee loses interest.  The message is out that the paper is damned with misfortune and politics so no other takers to finish it off.  The paper does not progress any further.

DISCLAIMER: This is of course a completely fictional tale and I could not possibly imagine it ever occuring in real life.  Thanks for reading and follow me on Twitter  @DrHenryWoo

Saturday, July 14, 2012

Transitioning to Robotic Assisted Surgery

I am a relatively late comer in adopting the robotic assisted surgical approach to radical prostatectomy for prostate cancer. If you look at this piece from the New York Times, you will understand why I have little real choice other than to offer this to my patients ( _r=1&emc=eta1). The article is now a couple of years old but we were able to resist being forced into this new technology in Sydney, Australia until now. This time last year, there was only one hospital with a Da Vinci robotic system. Having surgery performed at that hospital is expensive and compared to some surgeons fees elsewhere, multiples of times greater. Colleagues in Melbourne, where robotic surgery has long been the norm, have reported that they regularly saw patients from Sydney as a result of the cost of surgery there being significantly less, even allowing for flights and accommodation. When consideriing the maximum numbers of patients that could physically be treated at one hospital in Sydney, the finite numbers of men who were prepared to pay the large costs of such treatment and those prepared to travel interstate, these numbers were never going to threaten the viability of a urologist's prostate cancer practice in a city the size of Sydney. Fast forward to less than 12 months later, we now have 4 hospitals with Da Vinci systems that are up and running with another two hospitals likely to have systems installed by the end of this year. The dominos have well and truly fallen, but it was only a matter of time when the last Australian capital city strong hold of open radical prostatectomy surgery would buckle to the market forces. The acquisition of this technology at my hospital has meant that I have had to undergo intense training to make the transition. I am grateful for the fact that as a later adopter, I have had access to training materials that were not available to colleagues only a few years earlier. In recent years, an excellent surgical simulator has been developed and this has made a huge difference to my transition from open to robotic assisted radical prostatectomy. The need to train for robotic assisted radical prostatectomy seemed perfectly timed. I was due to attend the American Urological Association Annual Meeting in Atlanta and this provided a perfect opportunity to attend various live surgery opportunities at that meeting as well as to attend laboratory training whilst in the USA. At the AUA meeting, I made a point of attending a number of interactive live surgical demonstrations of the surgery being performed as well as attend scientific sessions relevant to the technology. Immediately following the meeting, I took a flight to the San Francisco Bay Area and took the opportunity to attend surgery being performed by the renown Professor Peter Carroll at the University of California San Francisco Medical Center. Apart from seeing the actual surgery, it was instructive to see the dynamics within the operating theatre set up. The next day, I attended the Intuitive headquarters at Sunnyvale where they have a large training facility. It was a full day of intensive training with just myself with one Da Vinci system allocated to me, one professional trainer allocated to me as well as one anaethetised pig upon which the surgery was performed. We were quickly reassured and could see first hand that the pigs were dealt with in a completely humane manner. It has been stated that 9 to 10 hours on the simultor ought to be a minimum amount of time spent on the surgical simulator. After I had done this for 9 to 10 hours, I was regularly achieving 100% scores in the numerous exercises offered by the simulator. when I thought carefully about my own progress, I recognised that my 100% scores were really about me having mastered the technique of getting the simulator computer to tell me that I am doing well. In reality, I certainly had the technical basics mastered but I was far from fluent with my economy of motion and where the operation of both the hand and foot controls felt close to being second nature. On this basis, I pushed on and did over 40 hours on the simulator. I also made a point of spacing out the sessions over a number of weeks and using the time in between to reflect upon my progress. Additional to the simulator, an excellent trainer device has been created. A plastic model the shape and size of a human torso houses a plastic bladder and urethra - this formed an excellent model upon which suturing of the bladder to the urethra could be practised. This stage of training was intentionally left until I had completed the hours that I had determined that I would wish to do, and had I attempted this stage after only say 9 or 10 hours on the simulator, I would not have been able to repeatedly join the model bladder to the urethra with evenly positioned and tensioned sutures. Additional to the above were hours spent doing the on-line training modules created by the manufacturers as well as countless hours watching recorded DVDs of the procedures as well as U-tube videos - this was probably in the order of 40 to 50 hours. As we approached the days on which I would perform my first cases, we did a 'dry run' in the operating room to clarify what went where and who did what. A proctor well experienced in this surgery was organised at my expense to attend my first three cases. It is generally recommended that at least three proctored cases be undertaken but I had decided from the outset that this was inadequate. A period of reflection followed my first three cases associated with further numerous hours watching procedural DVDs. A further two proctored cases were performed and these were also completely successfully performed procedures. These additional two cases gave me significant confidence that I was now ready to commence solo practice with this technology. Having done over 1500 open radical prostatectomy procedures in addition to taking the preparatory training well above the minimum requirements has in my mind made an enormous difference. Having said this, I still do not have the fluency that I enjoy with open surgery, but mainly because I am being overly cautious and prefering to take things slowly and at all times having the patient's safety as the priority over surgical pride in how quickly the procedure can be performed. For now I will continue to offer open surgery but robotic assisted radical prostatectomy is offered to those who desire this technology. The conclusions that I reach from personal experience (and clearly not on the basis of a scientific trial) is that the current minimum requirements before a surgeon can independently perform robot assisted radical prostatectomy should be raised to a much higher level. Nobody gets hurt by doing too many hours on a simulator or doing too many proctored cases. Patients will get hurt in learning curves when shortcuts are taken to get onto the bandwagon. Lets also get rid of the threshold of 20 cases to be officially gazetted as a robotic surgeon - all this does is encourage a race to get to this caseload experience which could be at the detriment of patient safety.