Fiftyfaces Medicine + Science

Aoifinn Devitt: Here is a major sort of division, I think, between what is mainstream psychiatry or should be mainstream psychiatry and what is generally regarded as mental health issues in the community at large. I do believe that mainstream psychiatry should focus on what I would call the Big Five. Schizophrenia, which is the bedrock psychotic illness. Then there’s bipolar disorder, which involves mania where somebody is psychotic and totally grandiose and out of control. Alternating in periods with severe depression. You can have depression on its own, melancholic depression, where somebody is so severely depressed that they will take to the bed, they will have delusions perhaps that their insides are rotting, they won’t eat, they may have to be put on a drip. You can also get very, very serious anxieties with obsessive-compulsive disorders, that where people are paralyzed with indecision. And then the last category is our severe personality disorders. I know personality disorder is a term that’s thrown around fairly loosely. Patrick Devitt: I’m Aoifinn Devitt, and welcome to the 50 Faces Focus Podcast, a podcast committed to revealing the richness and diversity of people in medicine and science. I’m joined today by Dr. Patrick Devitt, my father and co-host of the first series of Inspiring People in Law podcasts. He’s a consultant psychiatrist in Dublin, Ireland, and formerly spent time as mental health inspector. His area of specialty is community psychiatry and medico-legal psychiatry. He also has degrees in law and science. I’m excited to sit down with him today to discuss his career and perspective on modern medicine. Welcome, Patrick, or Dad, I should say. Thanks for joining me today. Aoifinn Devitt: Hi, Aoifinn. I’m delighted to be here, but also somewhat apprehensive. Because as a psychiatrist, I’m usually the one asking the questions. I’m on the other side of the table, and I’m seeing what questions are answered, what questions are not properly answered, and usually deflecting any questions about myself. So this is slightly out of my comfort zone, but I’m still delighted to be here and to chat to you. Patrick Devitt: Well, we’re always best— that’s where the magic happens, they say, is outside the comfort zone. So thanks for that. Let’s start by talking about your long and varied career, because you started off with a career in science, And you did a little bit of acting on the side, I think, way back then, at least on TV acting. Then you studied medicine as a graduate, moved into general practice, and then a specialty in psychiatry ultimately. Can you talk us through this journey going right back to where you grew up? And would you say it took any surprising turns? Aoifinn Devitt: I’d say it took a lot of surprising turns, surprising to me and surprising to others as well. But I just— I grew up in Dublin, Ireland, in a lower middle class, I would say, type of suburb. Two of them, actually, but they were similar enough. My father worked in a local factory in Cadbury’s, and my mother was a full-time homemaker. She would have called herself a housewife in those days. I was the eldest of six kids. My folks came from the country. They were rural farming people, and they had a huge emphasis and a huge grá, which is the Irish word for love, and respect for education. My father was the youngest of nine, and my mother, similarly, the youngest of nine. And that their older siblings had done very, very well, and there was a huge emphasis on education. So therefore, we were sort of hothoused in terms of education, and we were expected to get scholarships and go on to college, which was not that common a couple of years prior to when I left the equivalent of high school. It wasn’t that common. It was becoming more common, and there was free education. So at the time when I was leaving high school and applying to college, The thought of medicine had occurred to me because two other guys in my class were going to do medicine, but the general wisdom at the time was, ah, it’s very long, it’s 6 or 7 years, and then you’re training for ages. Ah, it’s too long. So I did science instead because maths was one of my favourite subjects and science was regarded as quite mathsy. So I did science and enjoyed it. I actually started off doing maths but got a total shell shock. At the first lecture, I didn’t understand one word. I thought I was great at maths. So that was the honours maths degree. So that was the cause of me switching over to science. And I ended up with a degree in chemistry and maths. And then I wasn’t interested in research. That would have been one pathway afterwards, or teaching was another pathway. That didn’t seem to open itself up for me. So I went into industry, applied for a job. I was lucky enough to get a job in a brewery where I worked for 3 years. Patrick Devitt: That was, of course, my earliest memory is you working in the brewery because I do recall you doing some commercial for that brewery, maybe around the same time as when you were applying to medicine. Aoifinn Devitt: Well, actually that was later. It was when I had done medicine. I was impoverished or relatively impoverished. Your mother was working as a teacher and I was going to college and I was doing private tuition in the evenings. I was doing, working during the summers. I was doing all sorts of work. I worked in Canada, worked in England. And worked in Germany during the summers. So I was bringing in the money all right. But another route for bringing in money was advertising, because we knew somebody who was in advertising, and he said, “With your good looks,” I think he was joking though, “With your good looks, you could get a job as an extra or starring on some of these commercials.” So I held a six-pack of Harp Lager where I had worked earlier. And my greatest claim to fame was when I didn’t have to show my face, And one of those ads, I just carried a six-pack and all you could see were my jeans and my boots. And another ad I had was where I lifted off a slice of cheese and all you could see were my hands. So that was the easiest money because you weren’t recognized. And being recognized was, was a bit of a pain, actually. Oh, you’re the guy from that ad, you’re the guy from that other ad. But I wasn’t famous by any means, but occasionally sharp-eyed people would recognize me. So that was after 3 years in the brewery. I went and did medicine. Why did I do medicine, you’re going to ask me next. I’m just guessing. I don’t know actually, really. I was interested in it, as I mentioned a slight interest earlier. We had some friends who were medical students and they liked beer and we liked listening to their medical stories. So we traded one for the other. And then your mother’s sister did medicine as well. And so it was, it seemed to be that the stars were aligning that I should actually think about it myself, it was that or go to Canada or go to Australia, where we had applied and had been accepted, just for adventure. And I suppose doing a degree in medicine was probably an even greater adventure. And luckily, it’s one that I got accepted for and went along with and enjoyed, enjoyed immensely, actually. Patrick Devitt: And just to put this into context, this would have been the mid-’70s in Ireland, which is probably quite typical that groups would have been going off to Canada, the US, Australia looking to find their fortune elsewhere. And funnily enough, I guess things get lost in the translation of family history. I actually thought your desire to go into medicine was triggered by me as a baby failing my hearing test. Aoifinn Devitt: That was a factor, all right. Yeah, I hated that people knew more than I did, and I still do hate them. That’s why I hate when you know more than I do. I always hate when people know more than I do. I feel at a disadvantage. It’s my insecurity. But yeah, that’s right, you were about ‘Well, you would have been very young actually, less than 6 months, around 6 months, and they were banging metal kidney dishes to see if you would react or blink, and you wouldn’t blink.’ We were at the pediatrician’s, and so it was— this was the prospect we were faced with, that our pride and joy was going to be deaf. But then as he was about writing the referral letter to get us more intensive testing, he was clicking his pen and you were looking over at the pen, looked back and forth when you clicked the pen. So obviously you were able to hear, but you had got so bored with the idea of kiddie dishes banging that you just didn’t react. So that was yet another trigger for interest in medicine. Patrick Devitt: So you then did medicine. Was that a graduate course back then? Aoifinn Devitt: No, there were no graduate courses in Ireland at that time. They were all 6-year courses, and it was very hard actually even to get any time off, even to make it a 5-year course. Now, I hadn’t done biology or any biological subjects in my science degree, which was a bit of a drawback. Had I done that, I probably would have got off what they call the pre-med year, which is a competitive year actually in those days. Even before my time, you’d have 300 people who’d go into pre-med, they called it, and 150 would get out the other end. They used to say, look at the person to your left and your right, one of them won’t be there next year in the first year of medical school, they called it. So it was a 6-year course. And I was obliged. I got off the chemistry and physics because I’d done those in pre-med. I did biology and social and preventive medicine, which was a bit unsatisfactory because I wasn’t properly part of the class. And then I was doing some work as well at the time, so I was falling behind. But eventually I caught up and passed the exams and progressed then to first med. Patrick Devitt: And just a quick question about that, because some of our listeners will be considering maybe going into a career in medicine, some as graduates. Before we move on to the rest of your career journey, how did that feel given you don’t like other people knowing more than you did, but you’re maybe one of the older students in the class given there was no graduate program at that time? And given you’ve also worked in the US where medicine is primarily a graduate degree and in Ireland where it’s an undergraduate degree, do you think any one system is superior? Aoifinn Devitt: I think there probably are advantages and disadvantages. I wouldn’t say one is superior to the other. There are advantages and disadvantages. Both of your brothers went straight into the 6-year course straight after secondary school or high school, and you could argue that the disadvantage there is that they don’t really know their own minds. The advantage is that their minds are probably at their peak and they lap up everything, and they’re usually the top cream of the crop, the top of their class, so they’re really bright and they get a very good head start, and they’re more likely, I think, probably to go into more research type of areas than the older entrance at graduate level. Of course, the advantage of the graduate level entry is the maturity of the individual. It’s a shorter course, it’s a more expensive course. We do have these graduate degrees in Ireland now. It’s about, I’d say it’s about 30% of the graduates now would be graduate entrants in Ireland now, and most of the medical schools have a graduate entry program. So the advantage is that they’re more mature, they know what they want to do, they don’t faff around doing various specialties after they graduate. And they’re more focused. On the other hand, I do notice that many of the graduate entrants, upon graduation from medicine, they end up going into general practice because they just don’t have the heart to go through the long training. Now, that’s a disadvantage in the Irish European system. Typically, it takes about 10 years before you become what we call a consultant in Ireland. In other words, you’re a specialist or an attending, the equivalent of an attending in the States. Whereas in the States, you go straight in after graduation, and within 4 years you can be an attending, depending on the specialty, of course. If you’re doing orthopaedics or plastic surgery, it takes a bit longer, but you’re cut and dried and you’re earning money. And you need to earn it in the States too. That’s the other aspect, because of the big debts and the high fees. The fees in Ireland, of course, are a lot less, and those who go in directly after school, they pay virtually no fees. Just some sort of administrative fees. And in fact, your brother’s fees for medical school were less than his secondary school or high school fees. So there are advantages and disadvantages, but I think it depends on the individual and the individual’s commitment as to their eventual success. Patrick Devitt: You didn’t find it particularly difficult being older than your peers? Aoifinn Devitt: No, I didn’t actually. No, I was married with one child, one beautiful child, and then another one came along then, and even more beautiful child came along then. And then by the time I’d finished, I had 3 children. We sort of had started our family before I did medicine, so we decided to finish. We started, so we finished. So that meant that it was different, of But, course. Um, no, the individuals were pleasant. I got on well with them. And I, I— once you get immersed in the subject matter itself and the fear and the embarrassment method of learning and so on, it’s a bond formation type of scenario. And especially then when you become an intern and work at the hospitals. I’m just reading a book at the moment called The Night Interns, which is bringing it all back to me of working in hospitals. It’s a fearsome experience, and you do bond very, very well with those sort of conditions. So no, I didn’t find it particularly difficult or awkward. Patrick Devitt: And moving now to general practice. So you did spend a significant amount of time in general practice and ultimately moved out of there. Can you just talk us a little bit about that experience, what you liked about it, and maybe why you saw maybe an interest elsewhere. Aoifinn Devitt: Yeah, I mentioned earlier that many of the graduate entrants, when they graduate, they end up— I don’t mean end up in the sense that they— it’s, it’s a bad choice, but it’s the easiest choice in Ireland to become a specialist. And general practice is regarded as a specialist now. It may not always have been, but it’s the easiest, most efficient way to become a specialist in Ireland. And that was the case for me even more so because you could go to general practice without a formal training program. Most people did 6 months of this and 6 months of that, usually obstetrics, pediatrics, general medicine, and some psychiatry. And that’s what I did as well. I did my own self-structured scheme, if you like, training scheme. And then I graduated then with the Royal College of General Practitioners membership examination, which really, it didn’t mean anything in monetary terms, but I suppose in terms of being qualified, it reassured me and reassured others that I was well qualified. So I started general practice because I wanted to get making money as soon as possible. After our intern year, you’ve got a provisional license until you’ve finished your intern year, then you get your full license. So in those days, you could do anything, actually. So I used to go around and do calls, house calls for an agency who would stand in after hours. So I drive around in the car to various parts of Dublin. I’d go in and see the patient. Prescribe whatever was necessary, refer to hospital if necessary, take the money if they were private patients, or register their details if they had a— what we call here in Ireland a medical card— where the government pays for all their medical treatment. So I started doing that, and alongside the work I mentioned in the other specialties, I went into general practice as soon as I could, which was within about 2 and a half years. I had set up my own general practice in our own house there was a garage beside the house which was converted into an office, what we call in Ireland a surgery, which is a doctor’s office. And I spent about 5 or 6 years at that, which I enjoyed. I enjoyed it immensely. And it was a great challenge starting totally from scratch. And because you’re starting from scratch and there would be another, say, 8 to 10 doctors in the general town where I worked, it was a suburb of Dublin, you would get all the disgruntled patients from the other practices. They’d say, oh, there’s a new doctor, there’s some raw meat that I can annoy, or I can find the solution to my problems, which for most of these people, their problems were insoluble really, because they were hypochondriacal type of patients. So that’s what I started with. That’s what you got. When someone came in the door, you didn’t say, no, I don’t want to see you, and you charged per consultation. So that meant then that I was dealing with a lot of sort of psychological problems. In that sense. And I’d done 6 months psychiatry as part of the training because they used to say that was very important. And in fact, they still say that 90% of psychiatric illnesses are treated in general practice. 40 or 50%, depending on the studies, of the work done by general practitioners is actually in psychological medicine. So I was getting a lot of that. And as I say, the type of patients were those who had psychological needs, because they were the changers and the choppers and changers. So it made me think, we’ve got this psychiatry aspect, I maybe I’m good at it. And I’d done the exam before I left. I’d done a year of psychiatry actually. And I’d done the exam, the first part of the membership, membership was the qualifying exam, equivalent to boards over here in the States. And I’d done the first part of that and passed the exam without too much trouble. So I seem to like it. And I seem to be fairly good at it. And it was satisfying intellectually. So after a number of years, I decided that I would continue my training in psychiatry. I’d already done a year, so I did another 2 years. And meanwhile, I continued the general practice in the evenings or part-time, and somebody else joined me to go over the data aspect of the practice. So that worked out fairly well. I qualified in psychiatry then, and then I was at a loss then to know what to do. So I went back to general practice. Because there were no real, for me, suitable vacancies in psychiatry. The reason why I personally left general practice is that I sort of felt I had no control over my day. If I felt like working hard on a particular day, it may be that nobody would turn up. If I felt like having an easy day, 100 people would turn up and you’d be working till all hours of the night. So in a way, the lack of control is a factor. That put me off general practice. But I thoroughly enjoyed it, the day-to-day fixing of things. And it’s all really problem-solving. Medicine is problem-solving. And then I went to the United States 2 years after that in 1990. And that was a toss-up then. I got a green card and it was a toss-up whether I would work in psychiatry or in general practice. I was qualified in both. But as it turned out, there was a greater need for psychiatrists in upstate New York where I’d identified as where I wanted to work. Because at that stage I was afraid of the murder rate in New York City and I wanted to get as far away as I could. So that worked out fine. I worked in psychiatry and then I had done a law degree on the side as well. So I had decided then that maybe forensic psychiatry would be something that I would be interested in. And that’s what I ended up more or less in forensic psychiatry and in general adult psychiatry, they call it. Patrick Devitt: Well, I’d love to now move to talk a little bit about modern psychiatry because you’ve kind of touched on that I think already the fact that so much of it is treated within the general practice setting certainly would raise the importance of awareness of conditions and perhaps the ability to detect them from the dialogue that’s going on within the general practice. And it’s also maybe also seems a little full circle in that we are returning maybe to more of a community psychiatry kind of framework. But I know when you started psychiatry, the institutional way of treatment was still quite dominant. Could you talk about what you’ve seen in terms of the evolution of psychiatry throughout your career, from institutionalization to community-based treatment now? Have those changes been for the better, in your view? Aoifinn Devitt: The changes have been for the better, yeah. When I was a medical student, we used to visit what we called the asylums, and they were set up in the late 1800s and early 1900s. The famous one was St. Brendan’s Hospital in Dublin. It was called the Grange Gorman Asylum before it it was sanitized by calling it St. Brendan’s. And then St. Ita’s was an adjunct of that, built out on the coast about 12, maybe 15 miles outside of Dublin, on the north side of Dublin. And that’s where I actually worked, in St. Ita’s, for the first year. And then I did another year then afterwards when I went back. So in those days, Ireland in the early 1900s was probably the country with the highest rate of institutionalization. Of patients. There was a phenomenal number of patients who were institutionalized. And why was that? It was to do with society. It was to do with probably society’s lack of tolerance for their own relatives who had either mental handicap, as it was called in those days, intellectual disability nowadays, or for psychiatric illness. And then there were no really effective treatments before the 1950s, with the advent of the medication promazine, called Thorazine in the United States and Rargactyl in Europe, was a total game changer in that those people who are psychotic and agitated were exceedingly less so after treatment with this medication, which sort of coincided— well, it was probably one of the factors which led to the community psychiatric or community psychiatry legislation in the United States in 1963. I think it was the last legislation signed by President Kennedy. And the idea was that people would be moved out of the institutions where there was obvious corruption and well-publicized corruption and very poor adherence to the human rights of the individuals and very bad setup in terms of architecture and in terms of the setting. So the community psychiatric legislation was to set up a network of community centers. And I’m just reading a very good article in the New York Times just a day or two ago on that. And it seems the problem was the money that was provided was for demonstration projects. It was for projects. And the thinking was, oh, when they see how great this is going to work out, the local entities, the counties and states, they will provide the money themselves. Of course, that was very naive. They took the money for the projects. The projects were great, but they weren’t prepared to put the money that they saved on emptying the institutions back into community psychiatry. And on top of that, there was very little reimbursement, which is another issue with American medicine in general, with American psychiatry also, very little reimbursement. So a lot of the community psychiatric centers became centers for the worried well, because there was more money. The worried well had good insurance, and they were getting their worries or their minor psychiatric illness treated in the community psychiatric centers. Meanwhile, the very serious conditions— and here is a major sort of division, I think, between what is mainstream psychiatry, or should be mainstream psychiatry, and what is generally regarded as mental health issues in the community at large. And this is sort of one of my hobbyhorses really, is that I do believe that psychiatrists, mainstream psychiatry, should focus on what I would call the Big Five in terms of— I’ll list them very briefly— schizophrenia, which is the bedrock psychotic illness, Then there’s bipolar disorder, which involves mania, where somebody is psychotic and totally grandiose and out of control, alternating in periods with severe depression. You can have depression on its own, melancholic depression, where somebody is so severely depressed that they will take to the bed. They will have delusions, perhaps, that their insides are rotting. They won’t eat. They may have to be put on a drip. You can also get very, very serious anxieties. With obsessive-compulsive disorders, that where people are paralyzed with indecision. And then the last category is our severe personality disorders. I know personality disorder is a term that’s thrown around fairly loosely. These are the 5 big conditions that psychiatrists should devote themselves to. Unfortunately, or maybe fortunately, to where people say, oh, isn’t it great nowadays that we have this great awareness of mental issues, mental health issues? And that people are not afraid to say they’re depressed. And usually they’re movie stars who have felt somewhat depressed, but they’re not depressed to the extent of needing hospitalization or needing the services of trained psychiatrists. So not to say that it’s not important to look after your mental health, of course it is, but at the same time, it’s not in the same category. And in a way, it takes away resources then from those who need it most. And also, in a way, if mental health issues are regarded as warm and cuddly. These people with schizophrenia who are untreated are not warm and cuddly. They can be quite challenging in terms of their behaviors, in terms of their living standards, standards of living, in terms of their hygiene, and in terms of housing. They’re frequently homeless, which is not a warm and cuddly image. So in a way, it would be much better if psychiatry now focused on the Big Five. Now, that’s not to say that these people have to be treated in hospital. Or in an institutional setting. They can be treated quite well through a network of hostels, residences that are supervised. Some of them are called wet houses because frequently these 5 mental illnesses are associated with substance problems, alcohol and other drugs. So a network of these type of settings with day hospitalization, day programs, sheltered employment, and good community mental health centers with a multidisciplinary approach—social workers, occupational therapists, psychologists, Doctors, of course, and nurses as well. So the serious illness can be managed in the community, but there has to be a proper investment in that. And in fact, that was the gist of that article in the New York Times just recently, and it’s along the lines of my own thinking, and that’s the way it should be. Patrick Devitt: Well, we will put a link to that article in the show notes because what you’re discussing, it really reminds me of the argument around autism spectrum disorder, how so many of those disorders have been maybe collapsed into one spectrum. And not given their own name, their own label. And whereas there may be advantages to that, because it broadens the category of maybe those who can get treatment, it sometimes minimizes the severe cases. And in a way, it can take from that. So it’s certainly a balance required, it seems. Aoifinn Devitt: Yes, I think that’s a very good parallel, actually. So I think you’re right, the advantage of educating the public is on the one hand, but the disadvantage is of miseducating the public as to the severity and the needs of those at the severe end. Patrick Devitt: I’m going to ask also about the holistic maybe direction that this is going in psychiatry as a whole. And we’ve done a full diagnosis there of the current state of psychiatry, but looking at some of the areas around the fringes, say psychiatry, the use of drugs, I suppose more use of drugs to treat disorders, as well as cognitive behavioral therapy and more, I suppose, other therapies around the edges. How do you think about the integration of some of these tools? Aoifinn Devitt: Yeah, well, when I was at medical school and when I was training for my psychiatric examinations, it was always beaten into us, the whole approach is always biopsychosocial. And in fact, somebody— I saw a presentation recently that said that maybe it should be the other way around. Maybe it should be psychosocial-bio should be the emphasis, because most of the intractable problems are around the social aspect and the psychological aspect. The biological treatments are medications and shock treatment, electroconvulsive therapy. They’re the only two aspects of biological treatment at present. Formerly, of course, in the United States, there were lobotomies performed, and they were a scandal actually, even though the, the man who started it won a Nobel Prize. But still, that was a total scandal. So that was a biological treatment that no longer exists. So the only two are pharmacology and electroconvulsive therapy, which is effective. There are some gung-ho psychiatrists who are more into it than others. Personally, I was— I’ve used it, of course, but I’ve always been reticent. I always felt that it would be better to maximize the pharmaceutical benefits first before jumping into electroconvulsive therapy, though it can be life-changing for somebody who’s moribund. And I mentioned the melancholic depressive patient who would be moribund and uncommunicative because of depression. So it can be life-saving there. It can be life-saving in postpartum situations after a baby when the psychosis can occur in a very devastating manner. So electroconvulsive therapy, it can be a very rapid re-entry into normality in that situation. And that’s sort of it really. So it’s, it’s a narrow enough range or armamentarium, as we would call it in psychiatry, And it’s the one that psychiatrists get bashed with the most. I think maybe we’re paranoid ourselves, but we believe that patients do bash us significantly, and they complain that all psychiatrists want to do is push pills, we’re pill pushers, and that we just want to medicate people and shut them up and so on. But I would argue that psychiatrists, we only want to use the minimum amount of medication necessary to curb the symptoms. But we also want to make sure that somebody has a home to go to, that they’re not operating under intolerable stress, that if they have a substance problem, that that should be treated also. And if they have relationship or family difficulties, that these would be addressed, that they have the opportunity for gainful employment to the best of their ability, and certainly the opportunity to actually work. So they need a house, a roof over their head, a place to work. They need to have friends and they need a social outlet and a feeling of autonomy. And these are all And possible. They’re the real success. In fact, it’s been shown that in schizophrenia, actually engaging in family therapy, engaging the family in how to manage and how to work with and how to optimize their own relatives, their sick relatives’ functioning, is the most effective way, along with compliance with medication., but the most effective way of ensuring less relapse. So it’s all very, very important. The drugs actually are a minor enough part of it. And in fact, once you get the drugs right, they’re easy enough to get right. The hard part really is putting in place a life for people whose lives are adversely affected by their symptoms. Patrick Devitt: It’s really interesting because this brings up a topic actually discussed with Brian, my brother, your son, regarding the importance of communication. And I think in every aspect of life, I think we underweight the importance of communication, fully understanding, perhaps essentially for the family, there’s this case, what they’re dealing with. And perhaps if more focus was placed on that, we probably will get closer to solutions. Let’s move now to the topic of diversity, because you mentioned some of my cousins and we’ve got a lot of female representation in our family, certainly in medicine. If you were to give the, maybe a score to the profession in terms of how much it represents all the diverse aspects of society. How would you say it would score today? Aoifinn Devitt: I’ll preface my answer to that just by giving you a little anecdote. When I was growing up in the ’50s and ’60s, any African man who was walking around a provincial town— and usually it was a man— the local people would say automatically to him, “Good morning, doctor.” It was assumed that he was a doctor who had come from Africa for training purposes. And then similarly, for any Asian man from India or Pakistan who was walking around a provincial town would automatically be assumed to be a doctor. So there always has been, in that sense, foreign diversity in Irish medicine. In those days too, the ratio of male to female would be probably around 70 to 30 or 80 to 20, but that has now reversed. So in terms of gender diversity, it’s more than 50/50 now, that there are more females than than males. And that’s probably— we talked earlier about the entry from high school, from secondary school. I think it’s well known that females perform better at these end-of-school exams than males, so they get more points. There’s a point system in Ireland. They’re more represented in the medical schools and therefore in the profession afterwards. Having said that, for whatever reasons, maybe socio-cultural reasons, And we talked about work-life balance earlier. Females seem to be more concentrated in certain aspects of medicine, certain branches of medicine. For example, psychiatry, it’s very difficult. The females are very overrepresented in psychiatry. I’ve retired from the public service now, but I was doing a locum at the early part of this year, and I just was remarking to myself at our multidisciplinary team meetings that I was often, out of 7 or 8 or 9 people, the token male there because the junior doctors, the trainee doctors, were female, the social workers were female, occupational therapy were female, and the psychologist was female. I didn’t mind, but I think a balance is necessary. So the other thing too is, similar to the way that primary school teaching has become almost exclusively female, it does on that basis, from society’s perspective, seem to be somewhat devalued in that the salaries where there’s a predominantly female representation don’t seem to match those where there’s a predominantly male representation. So that’s an aspect. And the other thing is that in surgery you will find females underrepresented, but in branches of the profession where there is a good work-life balance, I think the females are overrepresented. I mean, surgery, I think even in the United States, is a long slog of training. It’s even longer in Ireland, and it can be 10 or 15 years of training in various parts of the country, abroad, working long hours, working nights, which is not compatible really for an individual who wants to have a family. It’s very difficult. I think though maternity leave and all that is now available, but there has to be some sort of an affirmative action type of approach, I think, taken such that there is more equal representation in the more active type of specialties in medicine. Patrick Devitt: It’s interesting, I was going to ask you about glass ceilings, and it seems that there is a little bit of that given the perhaps the process required to rise to the top. And I’m sure also the lack of role models at the top has its own kind of self-fulfilling prophecy then in terms of encouraging. Aoifinn Devitt: Yeah, as you say, what you can’t see, you can’t be. The other point that’s quite interesting is that Irish graduates, I think they’re very well trained and they’re very much in demand abroad, particularly in Australia and also the United States, though not so much. But hordes of newly graduated Irish doctors after their internship go off to Australia and they stay for 2, 3, or 4 years. Some don’t come back. I think the majority of them do come back, but there is therefore a vacancy. Vacancies have arisen and they’re being filled by doctors from the Third World. And it’s argued that this is very unfair, that doctors are in much greater need in their own country, say in the Third World, are being lured to fill up the vacancies of the First World. I think there is a lot of racial diversity in Irish medicine, and I think in medicine in the First World there’s a lot of racial diversity, a bit less similar to the gender diversity from Third World countries. Don’t have the same opportunities. Patrick Devitt: I want to ask you a little bit about leadership because I’ve watched you move from an entrepreneur, I suppose, obviously as a general practitioner, into working in a team, into ultimately leading a team. Are there any philosophies about managing teams or leadership after your extensive career that you have now adopted and share? Aoifinn Devitt: Well, one of the best actual training sessions or training programs I was involved in was through New York State when I worked in Syracuse. There was a program called the Leadership Classroom, which was organized by the Office of Mental Health in New York State. And actually, I found that very good. The usual things like how to run an effective meeting. And of course, how to run an effective meeting is to know what the meeting is going to be about. So I think with any activity or any enterprise, you need to analyze and work out why am I doing this. And if it’s not for a specific purpose or if it’s not for for any purpose, don’t do it. So that’s the first aspect of leadership I would have thought, is a clear focus that’s articulated by the leader, but is also bought into by those being led, that we are here to do X, and we do X by doing Y, and we hope to achieve Z. So you have to have your principles laid out, and you have to have the methods for doing it, and not to be deflected then from that. I think when I was leading the community mental health team in the psychiatric service in Dublin, in Clondalkin, it was a well-known service in Ireland, we used to have regular meetings and we’d regularly discuss what we are. And what we used to say is we are a comprehensive community-based psychiatric service. We provide treatment to those who are severely mentally ill. We will assess those who have moderate illness and we will make recommendations and send them back to primary care., but we deal in the community from a multidisciplinary perspective. Occasionally we will admit patients who can’t be treated in the community, but we’ll discharge them as quickly as possible. So that was what we were about. So anytime an issue came up, what should we do, or how should we do this, or should we do that, it all revolved back to what’s our essence, why are we here. I think that’s the essence of leadership, actually, if everybody’s on the same page. But you have to keep on revisiting the mission. And I suppose that’s what it is, the mission. And some people are cynical about the term mission. And when organizations go into conclave once every year or every 2 years and come out with the very same wording as they’ve had previously, and people get cynical about missions. But in fact, on a day-to-day basis, it’s all about knowing what you do and why you do it. Patrick Devitt: That gets back again to that importance of communication and, and over-communicate and re-communicate again, which is just so important in teams. Aoifinn Devitt: Yeah, in a way you probably can’t over-communicate. I think communication should be constant. Of course, communication also means listening and receiving as well as transmitting, and they have to both— and you have to check that the reception has been achieved as well as the transmission, and check that what you transmitted, what you thought you transmitted, was actually what was received. And that’s a constant process. Some people think, oh, if I just give an annual type of account of the state of the nation, that’s enough. But it has to be on a day-to-day basis, really. Patrick Devitt: Well, speaking of, uh, I suppose finding one’s mission, one’s center, one’s purpose, you are an avid runner. I think you got me started at it, probably, since I used to cycle beside you on those 10, 12-mile runs in Malahide back in the ’80s. Why is running important to you? Aoifinn Devitt: Well, because I like it. I suppose that’s the first thing. Secondly, I think we come from an anxious family. My father was anxious, and there’s a lot of anxiety in our family. They were all managed at primary care level. They never— according to my earlier pronouncements, we would never need to have seen a psychiatrist because of anxiety. So running is a fantastic anxiety reducer. I often see people say who are injured at work, who’ve had a very vigorous exercise program prior to that, and they can’t cope with enforced idleness or restricted mobility because of the outlet for reducing anxiety is removed. So it’s a fantastic anxiety reducer. Another good reason, actually, it’s very communal, it’s very social. I mean, it can be either you can go out and sit a little quiet to yourself and meet people for the warm-up and chat and have a run together and then chat afterwards. So it can be very social as well. It’s also competitive, which is fantastic actually, because we mentioned earlier that out of the comfort zone. So getting out of your comfort zone and getting out of breath, there’s no nicer sensation. And then maybe actually beating a time that you had achieved previously and not knowing why in particular today was the day that you did so well. And there’s a great feeling of well-being afterwards. Also in terms of looking after one’s health, You feel better even when you’re not running. So I think I probably have enunciated most of them. If I went on any longer, I’d be competing with Murakami. Patrick Devitt: Yes, what I think about when I think about running. Well, you’ve certainly given us lots of food for thought. And my last question is whether you would have any advice for your younger self. Aoifinn Devitt: Well, see, I don’t think I was capable of taking advice at that age. I was like all young men, I knew everything. So would the advice have been any good at that point? I think that’s something you have to discover for yourself, to be honest. I don’t know if people take advice, young people, or if they want advice, to be honest. I think they have to make their own mistakes and discover their own interests and their own likes and their own skills and talents themselves and make their way in life, and knowing all the time that life is random. And the idea is that when something randomly good happens to you, recognize it, take advantage of it. If it’s randomly bad, it’s not your fault. Just get on with it. And sometimes one door closing opens a couple of other doors. Patrick Devitt: Well, that reminds me very much of what another doctor, not a medical doctor, but another guest on my main podcast series, Dr. David Kelly, another Irishman, said. He said that he doesn’t necessarily think people want advice, but they need people to believe in them. And I think as the daughter of a doctor, your daughter, I’d say that had been the greatest gift that you’ve given me. And I’d say that every child should have the benefit of being a podcast host. Because this has been a great pleasure to interview a parent. We went a little longer than typical, but I think that’s only because the journey has been so varied and so very interesting. So thank you for your ongoing intellectual curiosity and for sharing it here with us. Aoifinn Devitt: You’re welcome. It was a pleasure. Patrick Devitt: I’m Aoifinn Devitt. Thank you for listening to the 50 Faces Focus Podcast. If you liked what you heard and would like to tune in to hear more inspiring people and their personal journeys, Please subscribe on Apple Podcasts or wherever you get your podcasts. This podcast is for informational purposes only and should not be construed as investment advice, and all views are personal and should not be attributed to the organizations and affiliations of the host or any guest.

Aoifinn Dr. Brian Devitt: What’s one of the things that I often tell medical students is you can get into medicine with IQ, but you get on in medicine with EQ. And I think that was always emphasized, the importance of a good bedside manner, respect. I think you need to do is respect the individual, and that waiting outside the operating room when you’re seeing how the outcome of surgery is pretty frightening. And I think one of the things that I like to do is communicate. And we’ve all been at airports where our plane has been delayed and we get frustrated because people don’t communicate well. I think that happens a lot in healthcare. And I think one of the little things that takes 30 seconds of your day is picking up the phone after an operation and ringing a patient. It makes a huge deal, puts their mind at rest. And for me, that type of communication or that motto to treat people like you would like to be treated is really how I would live my life and my professional life. Dr. Brian Devitt: I’m Devitt, and welcome to the 50 Faces Focus Podcast, a podcast committed to revealing the richness and diversity of people in medicine and science. I’m joined today by Professor Brian Devitt, who’s a consultant orthopedic surgeon, professor of orthopedics and surgical biomechanics at Dublin City University. He studied medicine at University College Dublin and is a specialist in orthopedic surgery with a specialism in knees. He’s also my brother, and given that he has spent the last 8 years in Melbourne, Australia, and we’ve only seen each other a handful of times over this period, I’m excited to sit down with him and touch base on his medical career and outlook. Welcome, Brian. Thanks for joining me today on the podcast. Aoifinn Dr. Brian Devitt: Thanks, Aoifinn. Dr. Brian Devitt: Obviously, I know all about where you grew up and what you studied, but for the benefit of our listeners, can you talk us through that journey, how you came to studying medicine and orthopaedics in particular? Aoifinn Dr. Brian Devitt: Well, I suppose just to give the listeners a bit of background, our father is a doctor. So I grew up going to his surgery on weekends and just being around medicine. And there was a bit of a competition between medicine and law, as my two sisters, you being the elder, went into law, as our parents had dabbled in law at that stage. But I really felt more of a calling towards medicine. I liked the idea of speaking to people, I liked the idea of helping people, and it really— I was very fascinated by what was in my dad’s bag as a GP. And really, that was the early interest in medicine. As I went through school, then medicine was certainly, I felt, was an attainable goal and something I really felt passionate about in terms of my later teenage years and in terms of pursuing. So that’s really my background and interest in it. Dr. Brian Devitt: And of course, it’s fair to say it probably was a truly integrated experience we had with general practice, given that often the surgery was actually in the house in which we lived. So one had to keep the piano practice down and the family antics down when surgery was in process. Aoifinn Dr. Brian Devitt: Yeah, we certainly felt it all the time. And also in the fact that I realized the job involved a lot of commitment because I remember nights when our father had to go on call. I remember being taken on call one night and missing Halloween, which I was really crestfallen about. But we certainly realized that it was a calling, it was a vocation, and something which I really enjoyed the interest that my father had in this and that I wanted to pursue it myself. Dr. Brian Devitt: And speaking of other callings and vocations, so you’ve always been passionate about sports. You certainly excelled in that from a young age. How much of the direction you took in medicine into orthopaedics do you think is related to your passion for rugby and sport? Aoifinn Dr. Brian Devitt: Yeah, it’s— I certainly love rugby and I still do. I think a huge part. I think medicine is such a varied career. There’s so many opportunities one can pursue in medicine. And really for me, I really gravitated towards anything that involves sport. And really orthopaedics is probably the best specialty. We look after musculoskeletal injuries and sport is a very high-risk pursuit. So therefore a lot of musculoskeletal injuries I also recognized that a lot of my colleagues— I played rugby throughout my university years and a lot of my colleagues were orthopaedic surgeons who played rugby as well. So you kind of gravitate towards a career that you’ve— people that you respect and that you liked. And therefore orthopaedics as a specialty really interested me and sports medicine in particular, that facet of orthopaedics really interested me at an early stage. Dr. Brian Devitt: And just before we dive in a little bit more to modern orthopaedics, Over the course of your career, did it take any surprising turns? Did you study abroad besides Australia? What was your course like? Aoifinn Dr. Brian Devitt: I didn’t really have any surprising turns. I suppose I had a fairly routine practice in Ireland. The surgical training program is quite lengthy, so you do basic surgical training, so you got a taste of other specialties. So I would have done general surgery, vascular surgery, orthopaedic surgery, and cardiothoracic surgery at an early stage. And I was really fascinated by cardiothoracic surgery because one of the first specialties we I actually got to do hands-on surgery. And it was really a toss-up at that stage between the two. And I spoke to my consultant cardiothoracic surgeon who I was working with, and he recommended that I do orthopaedics. I was wondering, was it the fact that I wasn’t performing well with him? But he said that cardiothoracic was going to be taken over by endovascular surgery. So he thought that orthopaedics, it was a very nascent discipline, and he thought that I’d be well suited towards it. So that was really gave me the confidence to pursue it with vigour. And really that was probably the first crossroads I had to take in my career. After that, it was just a case of perseverance really, because it’s a long progress. You have to stay the course. I didn’t really do a huge amount of training abroad as part of my specialist training in Ireland, but I’ve since made up for that having finished my formal training in 2012. Dr. Brian Devitt: And let’s talk about modern orthopaedics now, because often when people have, say, a hip or a knee replacement, and I’m getting to an age where more and more of my peers are looking at that type of surgery, They say they feel like a new man or a woman, that it transforms their lives. How does this make you feel as a surgeon? Aoifinn Dr. Brian Devitt: Well, I think it’s a fantastic operation. I think let’s just take the hip replacement. I think some people might argue in different specialties, but for me it’s probably one of the best innovations in surgery over the last 100 years. And you talk about people, there’s a phrase where someone has a resting B-face where they’re not very happy and they’re a bit disgruntled and they’re not nice to be around, a bit of a mood hoover. And I often talk about the equivalent in a resting hip face because you’ve got this wizened look, the person is frowning, they’re constantly in pain. And when you do the hip replacement, it’s literally instantaneous. You go to them that night after surgery and they have a look that I don’t have that gnawing pain again. And really hip arthritis affects a huge number of people in our society and more so as we get older. So it really gives them a new lease on life, it allows them to mobilise and first and foremost, it gets rid of that pain at night. And you know well, if you don’t get a good night’s sleep, the rest of the day is very difficult. So getting a good night’s sleep is so important in having a good outlook, having a good mental health as well. So really you see people come back and the amount of times they embrace you at your first consultation visit, pre-COVID obviously, that you really feel like you’ve done a nice job. So it makes you feel great about the specialty you’ve chosen. Dr. Brian Devitt: And then you specialized in knees, are a specialist in knees. Why that area? And I suppose more broadly, what excites you about the field right now, orthopaedics in general? Aoifinn Dr. Brian Devitt: Well, I think knees, I suppose we all just, a lot of people pick the joint that they find most interesting. And certainly the knee, formerly I kind of thought it was pretty simple as like a hinge joint, but it’s not. It’s so much more complexity to the knee. And I think that really the advent of ACL reconstruction within the last 50 years has really transformed how we practice. That used to be a sporting career-ending injury. Now we can get people back to performing at pretty much the same level with reconstruction. But it’s really fascinating, there’s so many different techniques we can use to do the surgery. And I think what I mentioned earlier on is a nascent discipline really, when you consider the length of time we’ve been studying medicine for thousands of years, but really with orthopaedic sports medicine, it’s probably really only in the last 50 years. And we’re making huge progress. If you take for instance in the 1980s, they did the great technology of MRI. So first of all, we’re able to diagnose injuries better. And then also at the same time we had arthroscopy, which is essentially looking into a joint, and particularly the knee is how it’s used most, with the camera. So it allows us to do things minimally invasively. So we’re constantly refining the techniques of doing ligament reconstruction, fixing meniscus, the shock absorber in your knee, fixing the cartilage, and doing procedures and re-looking at procedures they used in the past for reconstruction and trying to reuse them now with modern techniques. And that was what my PhD was about to a large extent. So it’s a fascinating nascent discipline that’s really advancing year on year. Dr. Brian Devitt: And in terms of, of course, people living longer, mobility being a key ingredient of quality of life, how do you think this is going to contribute to better quality of life in our later years? Aoifinn Dr. Brian Devitt: Well, I think the consequence of people living longer is they’re going to be living with frailties and living with musculoskeletal failure. And a lot of times the musculoskeletal failure is arthritis. And that presents itself as pain and poor mobility. So really, I think being able to replace the joint and give that person the relief of pain, but also improve the mobility, is going to help them later on in life. And it makes them less dependent. And I think you really see that in elderly people, that they feel trapped in their own house because they can’t go for a walk, they can’t get to the end of a garden, pick up their mail, and they can’t get in and out of a car. So I think giving them the ability to do those things allows them a greater quality of life as they age. Dr. Brian Devitt: And in terms of the evolution, the ongoing evolution of orthopaedics and medicine in general, it seems that there’s definitely a more holistic approach being taken, perhaps more integration with nutrition or with physiotherapy or with maybe other aspects, maybe strength training. How do you see your practice evolving in that way? Aoifinn Dr. Brian Devitt: Well, I think that’s really huge. I think that you realize that it is much more than just doing a joint replacement. There’s the psychological aspect, Figuring out if patients are ready for surgery, what to expect. The great phrase, forewarned is forearmed. The people go into surgery, you have to let them know it’s a pretty big day out and it involves a lot of rehabilitation afterwards. And we need to be speaking to our other colleagues, physiotherapists, physical therapists, rehabilitation coaches, just so everyone’s speaking the same language. And I think then the other aspects of wellness in terms of nutrition is hugely important. I think we’re now recognizing the benefit of perioperative nutrition that if you consider, I know you’re a marathon runner and you you would prepare for a marathon by eating properly and then hydrating properly. It’s the same for surgery. We subject people to a massive insult in terms of physiological insult. So it’s really important that we’re aware how to replenish the losses with blood loss, but also nutritional losses around the time of surgery. So this is really important, and it’s become much more integral part of our practice that we would have a multidisciplinary approach and not just be the biological carpenters that we’re often called. Dr. Brian Devitt: Well, I have a lot of areas to cycle through, so if you apologize, I’m going to be a little bit whistle-stop on some of No problem. These. So let’s talk about the integration of sports and medicine because we’re seeing a lot of that overlap. We’re hearing a lot about psychology, say, and sports, and even sports psychology techniques bleeding into other aspects of our life, say, in our careers and our kind of corporate lives. What do you see in terms of the intersection of medicine and sport and maybe advances in that that you’re going to see over the next 5 or 10 years? Aoifinn Dr. Brian Devitt: Well, I think drawing on the psychology aspect of sports, and I’m just going to go on a little bit of tangent, I think one of the things I always recognized was as a sportsman back in my day, and not a very good one, you flattered me a lot, but you have to prepare for sport and you often use the techniques like visualization and getting ready for sport. I think the same attitude applies to surgery as well, that we’re going into a fairly stressful environment as part of surgery, and if you’re not prepared mentally, you’re going to fail. So one of the things that I often do, and it’s something as as just scrubbing your hands for surgery is you visualize. So you visualize the operation you go to do and you visualize the potential complications that you might encounter, and then you’re much better equipped to deal with them if they do occur. I think the other aspect of sport which I think is important is that I used to have the impression that it was a solo sport like golf or like tennis, but doing surgery is a team sport and it’s a huge team sport. I think if you watch the best surgeons operate, it’s the team around them that make them look good. And it’s really when you see it, how well choreographed it is. I’ve often described one of my mentors, watching him operate is like watching Riverdance, that it’s so choreographed and it’s, it’s a wonder to see. And that’s how it’s efficient and that’s why it’s good in terms of even lesser time operating, lesser risks of complications. So I think those aspects of sport and surgery are very alike. I think then you could draw in the other aspects of sport and surgery and more from the patient’s perspective and the psychological readiness to return to sport. I think that we need to appreciate that People have fears, and a lot of fears are borne out when you’ve had surgery because you feel very vulnerable. So it’s fears of reinjury, and I think that these things we need to engage with psychologists and saying it’s okay to feel afraid of doing things. And just because one person’s back playing sports at 12 months doesn’t mean you feel ready to play sport. And one of my colleagues, Professor Kate Webster, who I work closely with in Melbourne, has done a psychology scale in terms of the readiness to return to sport. After ACL reconstruction. And she’s found that there is a direct link between the score you get on your readiness and reinjury. So we have to appreciate if you’re not ready to return to sport, you probably shouldn’t. But there are methods that you can make yourself a bit more ready. And it’s a case of building confidence and trying to reduce those fears that you have. Dr. Brian Devitt: Absolutely fascinating. It reminds me of some of those criteria or scores we had to fill out postpartum in terms of assessing your postpartum kind of mental state. Really interesting how much the mental state is affecting, I suppose, even your physical outcome. Another area of overlap is academics and medicine, and you’re now a professor, and congratulations. And since we last caught up in person, I think properly, you’d completed your PhD. What do you like about academic medicine, and how now as a surgeon does it make sense to fuse those two careers? Aoifinn Dr. Brian Devitt: Yeah, I kind of fell into academics to a large extent. I think as part of our training program in Ireland, it was very competitive, so you had to do a higher degree just to be chosen amongst the 8 per year that we had on the training program. But when I did it, I really enjoyed it. I liked the writing, I liked the scientific element of it, and it reminded me of going back at school and science experiments, etc. But the academia, for me, it offers just a slight diversity from what we do in this stressful environment of surgery, and it gives you the opportunity to read up on the latest techniques. And it— I think it offers a longevity to your career that if you just did surgery all the time, you’d probably burn out. So that aspect of things really interests me. And the writing— I love writing, and I get a kick out of it, and which surprised me, but I really get such a buzz out of writing a paper. I think the other aspect of things is that we have to be aware we need to be at cutting edge, particularly with a nascent discipline, that you need to have evidence-based medicine. There is a great phrase that nothing ruins results quite like follow-up. So really, we have to be able to follow our patients and not just say they do well, we have to prove they do well. And I believe this is going to be integral in terms of how health funds are going to give money to certain hospitals or certain surgeons based on the results. And I think that’s going to be integrated into our healthcare very soon, actually. So I’d like to be at the forefront of that rather than scrabbling to catch up later on. Dr. Brian Devitt: This is a fascinating segue now to the question of training, because obviously you were trained as a doctor in Ireland. What would you say were some of the highs and lows of that, and maybe of your career so far, and places you’ve studied, places you’ve worked? And are there any lessons there that you learned that you would maybe pass on to a new medical student or graduate? Aoifinn Dr. Brian Devitt: So I did all my medical training in Ireland, and I’m very proud of the training we get. I think going on the lows, I think sometimes the pressures that when you train, you train in the public health service, so there’s a huge amount of pressure in the public health service and often relates to lack of manpower. So you’re often asked to work ridiculous hours and over 100 hours per week, and it’s not right for people to be working that hard or that long, and particularly when you’re making very critical decisions. So I felt potentially some of the issues which I feel sad about or feel that we could have done better were the fact that you were exposed a lot as a young doctor and it put you under a huge amount of stress. Now having said that, the responsibility one got as a young doctor probably made us better doctors in that you were able to take responsibility better and I think that made you being decisive. I think making decisions is critically important in medicine. So I think if I were to talk to a younger me, I’d say seek out help, seek out mentors early and ask for help. And then when you’ve got that help, once you’ve been given the responsibility, seize it and really take that responsibility because that makes you a better doctor ultimately. Dr. Brian Devitt: And having practiced in 4 jurisdictions in the US, Canada, Australia, and Ireland, if you were to say pick the best aspects of those different venues to practice medicine, What would you say that each region does well? Aoifinn Dr. Brian Devitt: Well, I did my first fellowship in the US in Vail, Colorado, and it was a research fellowship there. So I suppose for the first time I was able to see firsthand how you can integrate academia and private medicine at the same time and with excellent results. And one of the really impressive things I’ve found by working with the surgeons there is they were able to do the surgical procedures on cadavers or do it simulated before they actually did a complex procedure on patients. And that was amazing because you figured out all the anatomy, the little snags, and then you went in and did surgery and it seemed seamless after that. So that was really impressive how they were able to use the facilities they had to better their practice. I then went to Toronto. Toronto was more socialized medicine there, but I was really impressed by how they integrated the education with not just the fellows, but with the medical students and with the residents, that they had a really good educational program and really empowered the residents to become excellent decision makers. So that was very impressive. Australia is the time I probably spent most in practice as a doctor, as a consultant. So I was very impressed with the Australian system when I arrived. And it was probably the culture, but also how well-respected doctors were in Australia. And I think that they were able to practice not just in the private sector or the public sector, but they’re able to integrate them together because I think surgeons want to work. We are made of a certain makeup that we really want to get the most out of our day and try to work as hard as we can. Unfortunately, in some public sectors, you’re stopped working because it costs money and because there’s other issues. But in Australia, they tend to maximize your potential to work in the private sector, but then also allow you to give back to your profession within the public sector. So that was very impressive to me. And I’m only returned to— I’ve only returned 2 months, but I’ve been incredibly impressed in Ireland. Now I’m in private practice in Ireland. Ireland has taken all of those things and we’re really top of the box in terms of how well medicine is practiced. And I’ve been really impressed with the sports surgery hospital that I work in currently, how up to date it is, but how efficient it is and how they’re able to get through so many cases with such good outcomes. So that’s been extremely impressive so far. Dr. Brian Devitt: I suppose related to that, clearly efficiency is important. If you all want to work, you want to get the most out of each day, but how important is restraint as well? Restraint when it comes to whether surgery is even even needed, how can that lead sometimes to the profession losing credibility if too much is done? Is sometimes less more in this domain? Aoifinn Dr. Brian Devitt: I think you’re absolutely right. I think restraint is critical. And I think that we all often make the comment that no decision should be made in the operating room, they should be made in the clinic. So choosing to put someone on an operating table is a huge decision to make. And I often tell my patients, particularly when it comes to arthritis, because you get people presenting at a young age with arthritis, and I often tell them that surgery is not the right option for you. And that’s where you engage the other multidisciplinary colleagues like the nutritionist, like the physiotherapist, and like the strength and conditioning coach to try to postpone what may be inevitable in terms of a joint replacement. But you certainly don’t want to be doing it in a young patient. So I think as a doctor, I tell my patients, your objective is to avoid people like me in terms of surgery. You don’t want to have surgery at a young age. You want to postpone it for as long as possible. And they used to— one of my senior mentor used to talk about it, and he used to say that you have to get down on your knees to beg me to do surgery on your knee, and the only way you can’t do that is because you can’t get back up. So really, for me, that’s always been the teaching, is that I’m not a knife-happy surgeon. I love operating though, but I want to choose the operation that’s going to make the patient well and do it at the right time. Dr. Brian Devitt: Well, let’s just move to the topic of diversity in the profession. Whereas medicine doesn’t on its face seem to that much of an issue with, say, male-female representation. The area of surgery, maybe, and orthopaedic surgery in particular, might be perceived as a male-dominated profession, maybe in part due to some of the physical strength needed for some of the operations. How do you assess the level of diverse representation in your field and in medicine in general? Aoifinn Dr. Brian Devitt: Well, I think we’re really far behind, to be honest with you. I think that I remember trying to organise a meeting for a knee meeting in Australia, or certainly being part of a panel and they really struggled to find female surgeons with that specialty interest. And it really highlights to me that we’re quite far behind. And you’re right, I think medicine, if you look at the classes going into medicine, there’s a majority women in those classes. Yes, if you look in surgery, there’s a significant minority of women, but I think we’re better off having a more diverse group. I think that there’s a lot of machoism which exists, and I think when women come into the field, they kind of break that down. When you say, no, I can’t stay on because I have to go home and do something, if you’re a mother, I think that I think that I fully support more women in surgery, and I don’t think the strength issue comes into it a huge amount. I think maybe it’s a choice some people make, but I think it’s probably more the fact that it’s more regarded as a male-dominated specialty. I think as we see that our generation of doctors who have been exposed to more women in their medical classes and have seen how there are fantastic colleagues, as we become more of the leaders in our profession, hopefully that’s going to change because I certainly would welcome it. Dr. Brian Devitt: Well, let’s just get back to some personal reflections now. You’ve already mentioned some of the colleagues that you’ve worked with, you’ve quoted from some of the professors that taught you. Who were some of the key people who influenced you, and not necessarily only in your career but in life in general? Aoifinn Dr. Brian Devitt: Well, I suppose we have to first go back to our parents. I was hugely influenced by both our parents in terms of going into medicine and getting on in medicine as well. I think that what’s one of the things that I often tell medical students is you can get into medicine with IQ, but you get on in medicine with EQ. And I think that was always emphasized. They importance of a good bedside manner, respect. So I think first and foremost, the bedrock of my influence has certainly been our parents. I think when it comes to mentors, then you see people that you want to aspire to be like. And one of my professors, Professor John O’Byrne, who’s become quite a good friend, I liked his attitude. I liked the fact that surgery was important, orthopaedic surgery was his passion, but also his children were hugely important to him as well, and watching them grow up. And I didn’t want to be one of these surgeons that spent the whole time in the operating room that you have to have a life outside it to be a good doctor. So I think that he certainly influenced me hugely. And I think then my mentor of mine who’s now passed away called John Fagan when I was in Vail, Colorado, and he was such an impressive man. He was considered one of the forefathers of orthopedic sports surgery. So he was hugely influential with me and really helped me understand the history of sports medicine and surgery. And he really started off when they didn’t have the likes of MRI or arthroscopy, but had really welcomed in people people from abroad to see his surgical techniques. And then he introduced what we call the traveling fellowship, where we go around the world and we visit different centers and we share our expertise. And he recognized that this was the only way we’re going to move forward as a young specialty. So he was certainly very influential for me. Dr. Brian Devitt: And you’ve already shared some of the wisdom that these mentors have passed on to you, but is there any one or two pieces of advice that you’ve received that really made an impact on you, or any creed or motto that. Aoifinn Dr. Brian Devitt: You Well, I suppose treat people like you’d like to be treated yourself, and I think that all goes back to the Bible. I think it really, from my perspective, I’m lucky enough not having been a patient, but I’ve seen our mother as a patient, and I think that one of the things which I think you need to do is respect the individual. And that waiting outside the operating room when you’re seeing how the outcome of surgery is pretty frightening, and I think one of the things that I I really like to do is communicate. And we’ve all been at airports where our plane has been delayed and we get frustrated because people don’t communicate well. I think that happens a lot in healthcare. And I think one of the little things that takes 30 seconds of your day is picking up the phone after an operation and ringing a patient. It makes a huge deal, puts their mind at rest. And for me, that type of communication or that motto to treat people like you would like to be treated is really how I would live my life and my professional life. Dr. Brian Devitt: It. It’s interesting, executives in the business world are now referred to as not chief executive officer, but that they should be seen as a chief communications officer, because essentially communication is everything from team building to winning respect and to success ultimately. My last question is around any advice you would have for your younger self, whether it’s that young boy graduating from Belvedere or the young medical student making his way and deciding on what aspect of the profession should be his. Is there anything you know now that you wish you had known? Aoifinn Dr. Brian Devitt: I suppose I would have probably got into research earlier had I known it, and maybe that would have taken me away from the rugby fields a little bit more. And I certainly enjoyed my college life, I don’t regret anything about it. I probably didn’t excel as much during medical school as I maybe have done afterwards in terms of once I got passionate about it, I really invested myself in it. But getting into research at an early stage for a medical student is very advantageous. It puts you on a different bar to others. And that’s what I’ve recommended to our brother who’s in medicine, is that get a few papers under your belt and people just respect you a little bit more in terms of academia. So that’s probably what I’d recommend to my younger self. But the other great motto or creed which I have in life in general is don’t let orthopaedics ruin the holiday. So we had that for our fellowship, and life is more than your profession. And I think if you’re happy and you enjoy your job, you don’t go to work any day. So I think Confucius said that too. So a few added mottos in there. Dr. Brian Devitt: Well, of course, it could ruin a ski holiday or two if there’s a mishap, but I totally get that point. Well, thank you so much, Brian. I’ve always been incredibly proud to say that my brother is an orthopedic surgeon. Now I think, based on your creed, it’s now an evidence-based claim. So I hope I keep people like you at bay for at least a decade or two. Given my running habits, I’m probably flirting with the theatre, but it’s been a pleasure to speak with you and to hear your Bye, Grace. Aoifinn Dr. Brian Devitt: Thank you, Aoifinn. Dr. Brian Devitt: I’m Aoifinn Devitt. Thank you for listening to the 50 Faces Focus Podcast. If you liked what you heard and would like to tune in to hear more inspiring people on their personal journeys, please subscribe on Apple Podcasts or wherever you get your podcasts. This podcast is for informational purposes only and should not be construed as investment advice, and all views are personal and should not be attributed to the hosts. To the organizations and affiliations of the host or any guest.