A postcard from Sydney - Teleradiology at Everlight by Tony Booth, Consultant Radiologist
16 November 2017
I am writing this at 36,000 feet over the Java Sea on my way back to England for the first time in 10 months. Yesterday I was in Sydney reporting overnight CT scans of patients from multiple UK sites - a busy day with lots of pathology - two large subdurals, multiple PEs, diverticulitis, C diff colitis, appendicitis, facial bone fractures etc. A pretty standard night really.
I suppose my journey really began in early 2015. I knew that was going to be the year I would be making a decision about my future - my 60th birthday, the age I had planned on retiring, was 15 months away (a milestone I have now passed). My intention for many years had been to retire completely at 60 and develop new interests. However, as the months and years went by, I realised that 60 was the new 40; life is only just beginning and that boredom would almost certainly creep in. As I approached the finishing line, or what I had originally thought would be the finishing line, I was still looking ahead, and wondered what it would be like just to try something else before calling time on my career.
After all, I worked with respected colleagues who had continued working, not only beyond 60 but beyond 65. In addition, released from the burden of management and on call commitment, they were thoroughly enjoying their work. Their presence enriched the department, and their experience and opinions were valued. So my thoughts turned to continuing - at least for a couple more years.
At the same time, our son, who had graduated the previous July, had already planned to return to Australia on a working holiday visa. He had visited the country for 3 months, between school and university, and really enjoyed his time there. The time came for him to leave in February, and, typically for that time of the year (in the UK of course) it was damp and cold.
The first steps
The following week, after discussion with my wife, I decided to give Radiology Reporting Online (RRO) a call, and enquire about opportunities for radiologists in Australia. My son's departure had set in motion thoughts of working for a year or two in Australia, post retirement. Would it be the icing on the cake of my career?
After my initial discussion with RRO, it seemed that the biggest issue was "Can we leave our house, rent it out and feel happy and comfortable about the process?" About a week later, estate agents came round and we discussed the prospects. We were reassured that people renting property were just the same as we are, and would want to live in pleasant surroundings, and look after the house. The first steps to Australia were taken. The next step involved an induction into the RRO working practices and technology at the London head office.
Our visa applications, organised with the assistance of RRO proceeded with great ease and our subsequent departure from the UK was in a mood of feverish anticipation with a tincture of trepidation.
Neither I nor my wife had been to Australia, and most of our knowledge came from our son and a few relatives holiday experiences. Fortunately, any concerns were immediately swept away after arrival, and our excitement was more than justified. Sydney is visually a stunning city - especially when the sun shines - which is quite frequent.
Finding an apartment to rent proved to be easier than anticipated. The unit we found is located overlooking the southern end of Hyde Park, close to the Anzac memorial. As a location for us it is perfect: 20 minutes walk to the CBD and the RRO offices. Close enough to walk to work. Sufficient time for me to wind up in the morning and wind down after work. Behind us are the low rise areas of Surry Hills and Darlinghurst with lots of small cafes, restaurants, bars, cinemas etc. To the east is the upmarket area of Paddington, accessible via the slightly more "racy" sector on Oxford Road which takes centre stage at Mardi Gras. To the east lies Chinatown, a mere 10 minutes walk, where there is a fantastic vegetable and meat market, Paddy's Market. A little further on is the fish market- which is well worth a visit.
The Sydney Office
The team in Sydney are extremely friendly and welcoming and were a great help and support in easing me into my new role. They also throw quite a mean Christmas party for all employees! The work can be intense and fast paced at times, particularly at the start of the shift, between 10pm to 2am UK time. The experience in the NHS of taking many clinico-radiological meetings, and having to give opinion on cases quickly, without prior preparation, was good training for the work in Sydney.
Clinical Governance and Quality Assurance
As a radiologist working in a teleradiology environment you soon become aware that your work is under scrutiny from many sources. Radiologists at the client hospitals will check your work and report back discrepancies to RRO. In addition, RRO have a strong commitment to quality. They have a formal process of quality assurance whereby between 5 and 10% of every radiologists work is double-read. This is a very important process to maintain a high quality service. Of course, it's never a good day when you receive notification that you have missed something (they usually are errors of omission), but you get used to the scrutiny.
I see the system of checking as a positive educational force which makes you keep on top of your game and maintains high standards. How many Trusts have anything as robust a quality control system as this? We certainly didn't in my previous employment. I also attend virtual clinical governance meetings led by the RRO Medical Directorate and have access to RRO’s series of educational webinars run by leading sub-specialty radiologists.
Teleradiology comes under fire from many quarters. I think I was a committed, conscientious and caring doctor for the 36 years I worked in the NHS and I didn't suddenly change when I decided to retire and work for a teleradiology company.
I carry the same culture and values I had previously into my current role. My experience in the NHS was fantastic and I had the privilege of working with many talented and caring individuals from whom I learned a lot. I am now working with a new crew of equally talented and committed radiologists and at the same time speaking to doctors and radiographers all around the country. They are all my new colleagues.
A different experience and still learning
I now realise that retiring at 60 would have been a mistake. Changing jobs, working in a new way and seeing a different case mix has proven to be very stimulating in many ways. Working for multiple UK hospitals does mean seeing a wide range of emergency radiology. Even with more than 26 years as an NHS consultant with increasingly busy on call duties over the years I still come across new pathology or new variants. I have seen an aneurysm of the basilar artery nearly as big as my head, and an appendiceal mucocoele bigger than my head! I have seen obvious appendicitis and subtle appendicitis. Common emergencies such as ureteric stones and pulmonary embolism and rare cases such as the vascular form of Erhlers-Danlos. I have seen more trauma in the last 10 months than I had in the previous 10 years - or, perhaps even the previous 26 years. Many of the cases I see in my daily work have encouraged me to enthusiastically undertake further reading and research. I recognise there is still a lot to learn, even for an 'old lag' like me. Shortly before leaving for Australia, I revalidated, and thought that would be the one and only time in my career that I would do so. I am now looking beyond the next 5 years time and am definitely striving to revalidate in 2020.
Work life balance – it’s not all work!
My shift pattern in working 7 days on and 7 off allows me to adequately recharge my batteries, and enjoy life exploring Sydney and further afield with my wife. After 10 months of living in Sydney we are still finding new places to explore locally. For trips more distant, so far we have been to: Tasmania, New Zealand twice, the Margaret River area in Western Australia, Melbourne and the Blue Mountains. A future trip to the Whitsunday Islands is already booked, and a few more expeditions are in the early stages of gestation. I have also achieved a personal goal since coming to Australia. Most Australians become competent swimmers almost as soon as they can walk. I on the other hand had been a very poor swimmer. I never could get the hang of breathing out under water. Living in an apartment block with a 25m pool has helped me improve. I'm not exactly sitting by the phone waiting for the call up to the British Olympic Squad, but I'm certainly more comfortable in the water now. More importantly, no longer an embarrassment to my wife - at least not when swimming. Sydney is certainly a very pleasant, interesting and beautiful city in which to live. I was fortunate to have lived in Cambridge for many years and often wondered when I was running down The Backs on a cold, clear and frosty morning; when Kings College Chapel was back lit by the sun, if there could be a better jogging route in the world? Well, the run through the Botanical Gardens to the harbour on a sunny morning where the Sydney Opera House is backed by the Harbour Bridge might just be that. “