Seeing hospital through a patient’s lens

Dr Alisha Thomson has seen the health system from doctor, patient and management perspectives during her five years of treatment for ovarian cancer.

Dr Thomson was a 27-year-old James Cook University graduate in her second year of medical practice when she was diagnosed with stage four ovarian cancer. Discovering a new passion amid the demands of treatment ultimately led her to change her medical specialty training path. 

“I was a psychiatry house officer at that point. After a significant period of sick leave, I was given the opportunity to work as a medical education registrar through a return-to-work program,” she said.

“I went back to psych and then did some time as the medical admin reg and just really enjoyed the systems thinking and looking at the bigger picture. I loved psychiatry, and it took me years to finally switch, because it's hard to change lanes.”

Now a medical administration registrar, Dr Thomson has endured four rounds of chemotherapy as well as radiation, surgery, and therapies such as monoclonal antibodies and breast cancer drugs.

Her experiences as a cancer patient continue to inform her leadership role in improving systems and processes at Townsville Hospital and Health Service (THHS) and putting patients’ needs at the centre of decision making.

Asking the most important questions

“At the beginning of my journey, I thought I knew a lot about what patients needed,” she says. “I thought I was very empathetic. I learnt you don't always know what the most important thing is for your patients, which is why it's essential to ask.

“If you ask my oncologist, they'll tell you the most important thing in my life right now is to receive treatment and stay alive. But actually, the most important thing in my life is to feel like I'm not a patient 24/7, and to feel like I'm a person, so part of that means I am working full time.

“It reminds me of why we always need to ask our patients: ‘What's important for you? What's going on in your life right now outside of the disease process?’

Comfortable with conversations

“The reason ovarian cancer is often diagnosed late is the symptoms are so vague, but also because people don't feel comfortable talking about pelvic pain, bleeding, bloating etc. “

“In my five and a half years of having stage four ovarian cancer, I've only ever been asked by one health professional about my sex life. I said, ‘Thank you. It's been five years and you are the first person to ask a single female who's had multiple treatments, who's had her ovaries out, who's had hormone blockers, about her sex life.’

“It's okay to ask and in fact, sometimes your patient might be waiting for you to ask, and they're just waiting for you to signal to them that it's okay to bring that up.”

“If you don't signal that you're comfortable with sexual or reproductive health conversations, they will leave that clinic and maybe try and find another GP or never raise those issues.”

Rural and regional

Dr Thomson says navigating hospital appointments and procedures as a patient in Townsville and Brisbane has taught her lessons as a doctor and administrator, especially seeing what is involved for rural and regional patients undergoing treatment away from home.

“It's certainly been an eye-opening experience, but I think it's made me better at my job,” she says.

“Throughout my cancer journey, I've met a lot of women with ovarian cancer. I've been lucky in Townsville that I could receive chemo, radiation – everything bar the surgery – locally, where I could be supported, whereas I have a friend in Hughenden whose first rounds of chemo all occurred five hours from her home.

“On her recurrence, she was able to receive tele chemo. Those initiatives mean you can receive care closer to home where you're surrounded by loved ones and can be supported. It makes a massive difference to a patient, which I'd never fully appreciated until I was on the other end of it.

“It's not just the time the patient spends with you, it's the travel time, it's taking time off work, it's the filling out the travel forms to figure out how they can pay for this trip to go and receive treatment.”

She says tele trials, giving rural and regional patients the same access to clinical trials as in big cities, are an excellent recent advance and something for which regional doctors need to advocate for their patients.

Leadership and medical administration

Dr Thomson is working towards a Fellowship of Medical Administration, typically a three- to four-year program, with the Royal Australasian College of Medical Administrators.

“Part of the training is learning to lead others and to consider the whole health system. As opposed to treating the patient in front of us, we learn how to manage the system and to improve processes,” she says.

“The reason you have doctors doing that is to consider the patient factors and really put the patient first – so considering that person-centred care as opposed to how others might come at it from a purely management point of view.”

Dr Thomson gravitated towards leadership roles during her student years in the SANTE global health initiative and as a junior doctor representative on the Townsville Medical Staff Society.

Currently part of a gender diversity in medical leadership group in the THHS, she hopes to address barriers to gender parity in medical leadership. “In 2022 we should look around a room and see diversity and inclusion. To achieve this, we need awareness and organisation level initiatives."

Dr Thomson’s advice to a student or junior doctor considering specialising in medical administration is “to do it because you enjoy it”. You want to do it for the right reasons – if you are fascinated by the system and like looking at the bigger picture, feel strongly about patient advocacy, and value communicating with people. It's a worthwhile field.”

NQRTH connects medical students, intern and junior doctors with a network of opportunities and resources designed to create a supportive and clear path to specialist (including general practice) training, and beyond, in our regions. Our network works together to strengthen medical specialist training with the view to build a health workforce prepared to meet the health needs of our regional and rural communities in Cairns, Central West, Mackay, North West, Torres and Cape, and Townsville. NQRTH is facilitated by James Cook University, who partner with hospital and health services and training providers to create a connected career pathway beginning at the medical undergraduate level right through to fellowship.