Dr. Patrick Devitt

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.