Ep116. Mastering Emergencies - Inside the New Anaesthetic Crisis Manual with Dr David Borshoff

Ep122. From Theatre to Tribunal - Dr Gaby Bolton on Fair Pay for Junior Doctors

I am so grateful to Dr Gaby Bolton for taking time out of her exam preparation to have this conversation with me. Not only has she spent the last 6 years training in anaesthesia but she was also the lead applicant in a landmark class action lawsuit against Peninsula Health over unpaid overtime. Her journey began in 2020 as the HMO Society President, representing her peers as they sought a uniform allowance as they faced the COVID-19 pandemic. Dr Bolton took on significant professional and personal risks, and made huge efforts to support others. She spent months preparing for trial and endured days of cross examination in the witness box. It comes as no surprise that all of this, plus the media attention that ensued took a toll on her exam preparations. I am so pleased to announce that Dr Bolton has passed all exams! Dr Bolton also shares some great insights into performance anxiety and what drives her to advocate for those unable to speak up for themselves. A true inspiration! Our March 2026 edition of Australian Anaesthetist [https://asa.org.au/publications/australian-anaesthetist#latestAA] is all about advocacy. Read it here [https://asa.org.au/publications/australian-anaesthetist#latestAA]. Other podcasts you might be interested in: Ep115. How the ASA can support you [https://episodes.captivate.fm/episode/c6370e3b-5786-45dc-9055-1c5a03a058f6.mp3] Ep64. If you've failed exams [https://podcasts.captivate.fm/media/b3ec0d08-4d34-4f45-b417-ac217979226b/EP62-20I-20didn-27t-20pass-20my-20exam-20AAP-converted.mp3] Ep84. If you're navigating Ahpra [https://podcasts.captivate.fm/media/3ae30b18-665f-4bb8-aaa1-dfe703f235bb/EP84-Ahpra-with-AMA-Policy-Manager-Nick-Elmitt-AAP-converted.mp3] Buy your discounted ASA scrubs here [https://asa.org.au/shop] (login required). Some AI generated notes: Episode Highlights 00:02:15: I congratulate Dr. Bolton on passing her exams and contextualise why I delayed publishing this episode, setting up the significance of her journey 00:04:45: Dr Bolton explains the catalyst for the class action—a refused $8.87 weekly uniform allowance during the pandemic when junior doctors were required to wear scrubs to protect families 00:09:30: Legal firm Hayden Stephens approaches Dr Bolton after an AMA survey, warning her of potential career damage and requesting her to be the lead applicant for Peninsula Health 00:15:20: Bolton describes her meticulous documentation process, creating dossiers of two years of work records including pay slips, rosters, WhatsApp chats, and car park records for legal evidence 00:22:40: The trial is scheduled for June 2022, just six weeks before Bolton's primary exam, creating significant stress during her introductory training time 00:28:15: Bolton spends three-and-a-half days in the witness box, undergoing intensive trial preparation with barristers and facing cross- examination that challenges her authority as a junior doctor 00:35:50: A barrister questions Bolton's use of "my patients," implying she lacks authority; she responds by articulating the reality of junior doctor responsibility and accessibility 00:42:30: Bolton fails her primary exam four to five weeks after the trial, attributing it partly to performance anxiety that has affected her since age nine 00:48:15: Bolton discusses how performance anxiety only affects her in high-stakes personal evaluations, not in clinical emergencies or advocacy work for others 00:54:00: Bolton ultimately passes her primary exam in October 2024, with support from mentors who had also failed multiple times 01:01:20: Discussion of media involvement post-settlement, including media training and how Bolton balanced public advocacy with exam preparation 01:07:45: I ask about Dr Bolton's future interest in medical politics and wellbeing advocacy; Bolton reflects that advocacy "usually finds her" rather than being a deliberate choice Key Takeaways Systemic injustice requires individual courage: Bolton's decision to become the lead applicant, despite explicit warnings of career damage, demonstrates that protecting vulnerable colleagues, particularly IMGs reliant on supervisor sign-offs, sometimes requires personal sacrifice from those with more privilege or security Meticulous preparation mitigates risk: Bolton's obsessive documentation and organisation, combined with professional legal support and intensive trial preparation, enabled her to withstand three-and-a-half days of cross-examination and emerge credibly despite being a junior doctor facing institutional power Performance anxiety is context-dependent and treatable: Bolton's insight that anxiety affects personal evaluations but not clinical emergencies reveals the psychological distinction between ego-threat and external responsibility; reframing exams as service to patients rather than self-judgment may help trainees Peer support and realistic mentorship matter more than false reassurance: Bolton valued mentors who acknowledged uncertainty ("I don't have a crystal ball") over well-meaning colleagues offering hollow guarantees; normalising exam failure and creating space for multiple attempts reduces shame and isolation Advocacy often emerges from proximity to injustice: Bolton's journey from HMO representative to class action lead applicant to potential future medical politician illustrates how systemic problems, combined with individual values and opportunity, can reshape career trajectories toward advocacy Quotable Moments "I think they went around every single loophole they could to get out of paying something that wouldn't cover even a half a pair of scrubs to people to protect their families." "I felt at the time, maybe it was a little bit self-destructive and maybe has been in some ways, but I thought, well, I'm in a position to do it. It's something I think I'm capable of. It's something that I think I won't suffer consequences as badly as probably some other people would. And somebody has to do it." "They are totally your patients... I'm the one that's doing all their paperwork, putting all their drips in, changing all the medicines, talking to their families that no one's called for three days." "It doesn't affect me in anything except something that I value as affecting me personally. I've never had it at work in no way in any emergencies of work. It doesn't come up when it involves doing things for other people. But as soon as it becomes really personal and a direct judgment on me; it hadn't happened for a really long time."

EP121. The Social Script: What Doctors Should (and Shouldn’t) Post on Social Media with Dr Maria Li

In this episode I chat with Sydney General Practitioner and social media expert, Dr Maria Li on the best practices for doctors on social media. Dr Li has created tonnes of content, collaborated with over 100 professionals and organisations and is a member of the WHO's global FIDES network. We focus on 5 key principles for responsible social media use because I would love to see more doctors being a credible source of accurate information for patients on social media. I encourage you to look at the other content we produce and let me know what you think! YouTube [https://www.youtube.com/@AustraliaAnaes] LinkedIn [https://www.linkedin.com/company/anaesthetists/?viewAsMember=true] Facebook [https://www.facebook.com/AustralianSocietyofAnaesthetists] Instagram [https://www.instagram.com/asa_australia/] TikTok [https://www.tiktok.com/@asa_australia] Bluesky [https://bsky.app/profile/asa-australia.bsky.social] Useful articles from Ahpra and Dr Li: Ahpra social media guidance [https://www.ahpra.gov.au/Resources/Social-media-guidance.aspx] Social media is media [https://insightplus.mja.com.au/2025/14/social-media-is-media-a-crucial-reminder-for-doctors/] Popularity is not respect [https://insightplus.mja.com.au/2025/21/social-media-for-doctors-popularity-is-not-respect/] Your posts should reflect your judgement [https://insightplus.mja.com.au/2025/27/social-media-for-doctors-your-posts-should-reflect-your-judgement-not-your-stream-of-consciousness/] Never make fun of patients [https://insightplus.mja.com.au/2025/30/social-media-for-doctors-making-fun-of-patients-is-never-ok/] Comments count as content [https://insightplus.mja.com.au/2025/38/social-media-for-doctors-your-comments-and-messages-count-as-your-content/] Some AI generated notes: Episode Highlights 00:02:15: Maria Li explains how she started an Instagram account during lockdown in 2020 out of boredom, initially posting bland health promotion content that unexpectedly grew into a major passion project. 00:05:30: Maria discusses her organic collaboration approach—reaching out to subject matter experts on social media to co-create content, offering graphic design services as an incentive, and iterating through multiple drafts before publishing. 00:08:45: Maria describes joining the WHO's global network of social media influencers, explaining how centralised health messaging proved insufficient against decentralised misinformation on social platforms. 00:12:00: Maria establishes the foundational principle that social media is media—a public broadcast stage, not intimate conversation—using the example of a Victorian doctor deregistered by AHPRA for posting negative commentary about gay, Chinese, and Muslim people. 00:16:30: Maria explains how social media algorithms amplify content triggering outrage, fear, and anger, creating a trap where doctors unconsciously drift toward sensationalism. 00:22:15: Maria provides the example of a nurse who went viral crying in a hospital corridor after a patient death, only to face intense backlash for appearing to exploit the tragedy for engagement. 00:28:45: Maria warns against making fun of patients through role-plays and mocking videos, citing the Santa Barbara urgent care clinic staff who were terminated after posting videos laughing at patient bodily fluids. 00:35:20: Maria addresses patient privacy concerns, explaining that identifiers extend beyond names to include tattoos, distinctive features, and contextual details that could enable identification even without explicit consent. 00:42:00: Maria illustrates how comments are public content through the example of "Dr. Jane," an obstetrician who received a formal complaint after arguing heatedly in a local Facebook mums group 00:48:30: Maria emphasizes that following trends exhausts creators and confuses audiences. Key Takeaways Treat every social media post as a televised interview with your name and credentials displayed—the regulatory standard for online behavior mirrors in-person professional conduct. Prioritize credibility and respect over viral engagement; algorithms reward emotional arousal and controversy, but this conflicts with building sustainable professional reputations. Comments, screenshots, and deleted content remain permanent evidence; assume all social media activity is discoverable and can trigger formal regulatory complaints or reputational damage. Quality and authenticity matter far more than posting frequency; doctors can build loyal followings by staying true to their genuine interests rather than chasing algorithmic trends. Patient privacy extends beyond names to distinctive features, contextual details, and even background appearances; when in doubt, obtain explicit consent or increase anonymization. Quotable Moments "Social media is media. That's the principle. Social media is actually really good at fooling us into thinking that it's intimate and it's personal." "The moment you do post, you actually completely lose control of who sees your content. Kind of like a radio interview. Once you say what you say, you have no idea who's listening." "Before you make a post I want you to actually ask yourself this question: would I say this on TV with my name and my job title on the screen? If the answer is no why would you say it on social media?" "Attention doesn't equal respect. Attention doesn't equal credibility. So that's what I mean when I say popularity isn't respect." "You don't need to win arguments online. People get really up in arms about winning an argument against someone they've never met. You don't need to. You can just walk away." "Your superpower is whatever you genuinely care about, even when nobody's watching. Create what you're passionate about and you don't need to attract an audience. They will find you."

Ep120. webAIRS meets M&M with Dr Yasmin Endlich

In this episode I chat with Dr Yasmin Endlich, Medical Director at webAIRS, web based Anaesthesia Incident Reporting System. We currently have over 13,000 reports in webAIRS, making it one of the world's largest incident reporting systems. We chat about the various analyses (currently over 30 underway!), what's happening behind the scenes and how we will be discussing de-identified incident reports at the up and coming Australian Society of Anaesthetists M&M meeting. I also couldn't help discussing safety-II principles - examining what went right to prevent harm rather than only analysing failures. Three action items to consider: 1. Come to the next ASA M&M meeting! 29th June 2026. Complimentary registration for ASA members. Register or find the next event here [https://asa.org.au/asaeducation/events] 2. Join [https://www.anztadc.net] webAIRS user, if you haven't already. Any anaesthetist or trainee member of the ASA is eligible. 3. Report your incidents. Including the near misses. Help us better develop a safety-II approach Three more podcasts on webAIRS: Ep54. webAIRS with Prof Martin Culwick [https://podcasts.captivate.fm/media/5940c2ae-2f7a-4174-ad3a-869ac46ccc64/ASA-2054.mp3] Ep57. webAIRS: Lingual Nerve Injury [https://podcasts.captivate.fm/media/f4cc8ce3-390c-42f2-8e3f-d44917dfdba1/EP57-20Lingual-20Nerve-20Injury-20AAP-20.mp3] Ep79. webAIRS: Jaw Dislocation [https://podcasts.captivate.fm/media/cf949d95-0e23-4fc7-bded-e54dabe7c75d/EP79v2-jaw-dislocation-AAP.mp3] Some AI generated notes: Key Takeaways webAIRS is the world's largest anesthetic incident reporting system with over 13,000 reports, enabling rare event analysis and evidence-based safety improvements across Australia and New Zealand. Safety-II methodology—analysing what went right in near misses and no-harm events—offers a complementary approach to traditional incident analysis and may drive more effective safety interventions Implementation science remains underdeveloped in anaesthesia. Most institutions adapt to safety recommendations but rarely publish their implementation processes, limiting knowledge sharing and replication webAIRS supports institutional M&M programs through anonymous, de-identified case access with categorization tools. ASA is launching exclusive member M&M events using webAIRS data Registration with webAIRS offers dual benefits: self-reflection and learning for individual reporters, plus contribution to community-wide safety analysis. Reporting is legally privileged, anonymous, and eligible for CPD credit Quotable Moments "We understand that the health system is a complex beast, which we as humans are constantly adapting and adjusting or creating workarounds to keep things safe for our patients and usually efficient as well." "We report a lot. So the numbers of our reports are there. Then they get assessed. But the reporting back and then looking at systems and then looking how to improve things and going up the pyramid to reduce adverse events, that's basically where it stops in most healthcare areas." "It's not only important for oneself when you report as it's a part of self-reflection. It is a part of working through an incident yourself as well. But it also benefits the wider community." "We don't want is anybody who has reported an incident feel like, oh, we are not treating the data safely. We 100% are. And it will stay anonymous and it will stay completely de-identifiable as well."

Ep 119. Thoughtfully, Forever

In this episode, I'm reviewing an article that was published in the April 2026 Anaesthesia and Intensive Care journal (AIC). It's all about sharps waste management! A snapshot (literally) on what we are placing in our sharps bins and whether there is any room for improvement (spoiler alert - yes, there is plenty!). I also share some insights from my Sabbatical in Switzerland. This podcast accompanies the poster designed by Dr Nathan Chin in the June 2026 Australian Anaesthetist magazine. Download your free copy here [https://asa.org.au/resources/publications]. To read the scientific paper from AICm click here [https://journals.sagepub.com/doi/10.1177/0310057X261433580]. You may need your ASA login to access it. Three more episodes you might want to listen to: Ep69. Talking TRA2SH - trainee led research into sustainability in healthcare with Dr Jess Davies [Ep69. Talking TRA2SH - trainee led research into sustainability in healthcare with Dr Jess Davies] Ep96. Introducing Prof Philip Peyton, new editor in chief at Anaesthesia and Intensive Care [Ep96. Introducing Prof Philip Peyton, new editor in chief at Anaesthesia and Intensive Care] Ep114. Laughing Gas, Serious Waste: Measuring Nitrous Wastage with Dr Ethan Fitzclarence [Ep114. Laughing Gas, Serious Waste: Measuring Nitrous Wastage with Dr Ethan Fitzclarence] Some AI generated notes: Episode Highlights 00:00:30: Introduction to the sharps bin contamination study from April 2026 Anesthesia and Intensive Care journal, featuring artwork by anaesthesia trainee Dr. Nathan Chin 00:02:15: Sharps waste disposal costs 30 times more than general waste, with incineration producing 10 times the carbon footprint of regular waste disposal 00:04:45: UK data shows sharps disposal produces 50 times more carbon dioxide emissions compared to recycling 00:06:30: Zurich, Switzerland example demonstrating the "polluter pays principle" through mandatory tax-added garbage bags and strict recycling enforcement 00:10:20: Study methodology involved photographing sharps bins and counting non-sharps contamination across multiple hospital sites 00:12:45: Key finding: 79.5% of non-sharps items could theoretically be recycled, but only 18% could realistically be recycled with current hospital infrastructure 00:15:30: Most common sharps bin contaminants include glass vials (propofol bottles), plastic syringes without needles, IV lines, endotracheal tubes, and single-use stainless steel instruments 00:18:15: Only 19% of surveyed hospitals can recycle plastic syringes and one-third can recycle plastic ampoules, with glove recycling available at only one surveyed site Key Takeaways Healthcare waste management practices significantly lag behind residential recycling standards; implementing systematic segregation at point of use could dramatically reduce environmental impact and costs Policy presence alone does not ensure compliance—hospitals must invest in infrastructure, education, and accountability systems to translate waste management guidelines into operational reality Individual clinician behaviour change is achievable and impactful; simple actions like detaching needles from syringes before disposal can redirect substantial waste from expensive sharps streams Hospitals should audit their recycling capabilities and partner with waste management providers to expand options for plastic syringes, glass vials, and metal instruments currently defaulting to sharps bins Quotable Moments "Sharps bin waste is the most expensive waste to get rid of, both from an economic perspective and also in terms of the impact on our environment." "Getting rid of sharps waste could be 30 times more expensive than getting rid of general waste. 30 times!" "Sharpe's disposal, the autoclaving crushing landfill type of disposal, produces 50 times the amount of carbon dioxide emission compared to recycling. 50 times. Whoa." "We buy stuff, we open endless amounts of packaging and we don't think about how or how much it's going to cost to dispose of it." "Nearly 80% or four in five items could have been recycled for perhaps one 50th of the carbon footprint. That is astounding."

Ep118. Trauma Informed Care with Brigette Berry

In this episode, I explore trauma informed care with expert clinical psychologist Brigette Berry who specialises in acute and chronic pain. We examine five core principles of Fallot and Harris (2009): safety, trustworthiness, choice, collaboration and empowerment. Trauma informed care benefits all patients, not just those who have disclosed trauma. For example, many women may have undisclosed trauma, children and neurodivergent people could all benefit from the application of these principles. Brigette recommends the Blue Knot Foundation [https://blueknot.org.au/] for support and further training. Three other episodes of the Australian Anaesthesia podcast you might enjoy listening to are: Ep55. Hypnotising children! with Drs Annette Webb and James Auld [Ep55. Hypnothttps://podcasts.captivate.fm/media/99504620-4e5e-452e-9627-1b3dce8843b9/ASA-20Podcast-20Episode-20055-20v3-converted.mp3ising children! with Drs Annette Webb and James Auld] Ep60. Communicate like a Boss with Dr Andrea Wojnicki [https://podcasts.captivate.fm/media/79e68d74-37ea-4fad-af05-020e0aee751f/V3-20-20Communicate-20Like-20a-20Boss-20-converted.mp3] Ep83. The Women's Empowerment and Leadership Initiative (WELI) with Prof Nina Deutsch & A/Prof Larry Schwartz [https://podcasts.captivate.fm/media/ee9632df-8266-49ed-ac54-d1474a1382b7/EP83-Women-s-Empowerment-AAP-converted.mp3] Let me know if you're interested in the Blue Knot training or any other feedback: podcast@asa.org.au Some AI generated notes: Episode Highlights 00:02:15: Suzi introduces the concept of non-technical skills as essential core competencies for good doctoring, noting that anaesthetists can inadvertently contribute to patient trauma through insensitive communication. 00:05:30: Bridgette defines trauma using DSM-5 criteria as experiencing a literal or perceived threat to life, and notes that general anaesthesia itself may constitute a perceived threat to self. 00:08:45: Discussion of statistics showing one in three women have experienced interpersonal violence, emphasising the prevalence of trauma in patient populations without requiring explicit disclosure. 00:12:20: Explanation of the five trauma-informed care principles from Fallot and Harris (2009): safety, trustworthiness, choice, collaboration, and empowerment. 00:15:00: Practical safety applications including physical environment modifications (lighting, noise reduction), narrating procedures, and obtaining consent for physical contact. 00:22:30: Bridgette highlights unconscious behaviours in healthcare settings, such as lifting blankets without introduction or consent, demonstrating how small actions affect emotional safety. 00:28:15: Discussion of preoperative communication using positive language and imagery to support post-operative recovery and self-efficacy, referencing hypnosis-based communication techniques. 00:35:40: Bridgette introduces the COPE AHEAD skill from dialectical behaviour therapy as an evidence-based framework for imagined rehearsal and coping strategy preparation. 00:42:00: Emphasis on maintaining professional boundaries and respectful containment as essential components of trustworthiness, alongside being curious about fostering safety. 00:45:15: Bridgette recommends Blue Knot Foundation training and resources as practical tools for implementing trauma-informed care in healthcare settings. Key Takeaways Trauma-informed care is universal best practice applicable to all patients, not only those with disclosed trauma histories, and benefits neurodivergent individuals and children equally. Simple acts of narration, consent-seeking, and signposting (e.g., "I'm about to put the drip in") significantly reduce threat perception and build emotional safety without requiring additional time. Anaesthetists have a powerful preoperative role in setting positive post-operative outcomes through clear expectations, anxiety reduction, and empowering communication that improves both physical recovery and patient trust in healthcare systems. Individualisation within a trauma-informed framework is essential; clinicians should remain flexible and responsive to patient cues, recognising that some patients may find excessive choice overwhelming while others require it. Professional development training through organisations like Blue Knot Foundation provides practical, evidence-based tools for implementation, and adopting these principles requires ongoing humility and willingness to unlearn and relearn practices. Quotable Moments "There is always something more to learn, something more I can improve upon." "One in three women have experienced some type of interpersonal violence, as an example. So if we think about one in three patients that we see for anaesthetic procedures, you know, there's a high proportion of those who experience traumatic events." "Re-traumatisation is a very real thing. And I guess when we go through the principles, I can dive in slightly further. But we know, especially for those who have been through the more kind of chronic, prolonged, inescapable traumas, that are cumulative, we're less likely to feel safe within our own bodies." "Even if we're asking the question of, is there anything else we can do in this space within reason that could make you more comfortable? That's really therapeutic than just not asking and making the person feel like they can't advocate for anything." "It's the spirit of cooperation. So that may have to involve negotiation for the specific person in front of me." "Being curious about how can I foster more safety. I think training, professional development training within your setting is really, really helpful." "It's very humbling though, I will say, working in a trauma-informed way. So there's always stuff to learn unlearn, relearn, you know, and it's about humbling ourselves enough to be okay with that process because it makes us better clinicians and then it gives our patients a better experience."