00:00:00: Hello everyone, my name is Dag Le and I'm the host of UG Talks.

00:00:03: Educational and hopefully fun dive into GI World & Beyond!

00:00:07: We're happy to have you with us for another exciting episode.

00:00:11: And today we are back from Hobbitland Back there and back again... ...and i am extremely Happy To present Today's Guest Legendary Past.

00:00:20: UG President Professor Paul Fockens.

00:00:23: Welcome back Paul.

00:00:25: Thank you.

00:00:25: It's a pleasure to be here again, and I'm actually quite happy with the invitation to look back on my last three years.

00:00:32: We are very excited because the last time we spoke You were in New Zealand scoping and teaching after leaving your chief position at Amsterdam UMC And you left us with the notion that there is a prospect of black hole.

00:00:50: So where did it lead?

00:00:52: It definitely

00:00:54: didn't fall, mate.

00:00:55: And I think...I was not really scared of the black hole because it's a big change if you stop from active just medicine etc.

00:01:06: and start doing some other things.

00:01:08: but also in my case is quite nice to work.

00:01:13: Ethics are little bit less stressed so everyone takes their time and everybody is friendly.

00:01:22: slow down, take time for every patient.

00:01:24: So it was an interesting kind of step-down I would say until we arrived back in the Netherlands March

00:01:30: first.".

00:01:31: So this experience did change your perspective on being a doctor and medicine as a whole?

00:01:39: The slowing down...

00:01:41: No i think what about that?

00:01:42: really showed me there is different ways doing it And its always quite easy to see well the way you do it.

00:01:49: thats best way.

00:01:51: thirty patients in the morning, and we can see thirty-five in the afternoon.

00:01:55: The New Zealand idea is much more of okay.

00:01:58: if it's a patient goes on waiting list?

00:02:00: And the waiting list may be quite long but when that person comes into the office everyone has time for this patient.

00:02:07: so typically they schedule half an hour for every consultation which On one hand, with my Dutch vision I thought okay but in thirty minutes you can do two or maybe sometimes three patients if it's quick etc.

00:02:22: But that is kind of a different attitude and i think it was very interesting to study or work on this attitude because its probably better work life balance than we had at Amsterdam.

00:02:34: We do like that.

00:02:35: Yeah absolutely!

00:02:36: And then may be... One more thing The patients are used to waiting, and it's not that they're just sitting there.

00:02:44: And they will wait forever

00:02:45: etc.,

00:02:46: They'll definitely call you or they won't.

00:02:48: but they accepted it takes time.

00:02:51: Then also know when they see the doctor then all of them have a lot more time to discuss other things.

00:02:57: so yeah its different.

00:02:58: Of course volume is lower sometimes I think in Netherlands probably in Europe especially US too active and so if you catch a cold, you can try to go to the pulmonologist next day but it's probably very useless.

00:03:17: So people think oh I have a sore throat and need to see... And that also works.

00:03:22: in what kind of model your working?

00:03:24: If everything is financial incentive like private practice etc.

00:03:28: well then there actually wind-wind situation for doctor and patient.

00:03:33: Indeed What you're I think emphasizing is that there's cost-benefit difference here, where do we invest in volume or quality and the waiting list.

00:03:46: But this difference did it make your job more enjoyable?

00:03:51: In New Zealand

00:03:53: yeah i think was working hours were completely different.

00:03:58: everyone starts around eight or a thirty.

00:04:01: They see a lot of patients, but they probably take the time for their patience.

00:04:05: So if you work hard or have little bit less number of patients and smaller numbers of patients... But then get very good care which also gets in Amsterdam

00:04:16: etc.,

00:04:19: it's just different attitude.

00:04:20: Okay so maybe its what society agrees on?

00:04:24: What we prioritise as whole I might wait longer gets the best care.

00:04:32: Yeah, that's kind of which is I think for cancer.

00:04:35: if you're diagnosed with cancers off course they had clear timelines etc.

00:04:40: but even then sometimes well we need time for everything.

00:04:45: so yeah it's completely different and attracts definitely some people from other sides of the world.

00:04:50: We have a couple American colleagues who are not really happy.

00:04:58: well, work a lot and of course for a lot of money but they thought the work-life balance was off.

00:05:03: And they were very happy to go through New Zealand.

00:05:06: I think you have to be below forty or below forty five because then not addressed to you.

00:05:12: But when your below forty four or forty five Then in new zealand knows that if you stay You'll still work for twenty five years.

00:05:20: They're not searching For sixty year old people Because their benefit is small.

00:05:25: That's also part taking care of your health.

00:05:28: Yeah,

00:05:30: so New Zealanders make their priorities known?

00:05:34: Yes I think there is about twenty or twenty-five percent of the patients have private insurance and it's a mixed system.

00:05:43: The problem with the private versus public patient is that they can get everything whatever day you want to take on And in public its not okay.

00:05:54: So It feels a little bit unjust.

00:05:56: I think we're already now in the Netherlands suffering and trying to find out how we can actually keep quality up with more patients, more elderly patients.

00:06:09: Physicians retiring receive physicians prefer now towards three or four days a week instead of five or six.

00:06:17: so there's big issues i think health care around world.

00:06:21: indeed they optimisation somehow is optimizing us as human beings, both patients and the personnel.

00:06:30: Two more brighter frontiers because you've been at top of a game on playing fields past UG president chief of Amsterdam UMC And for highly successful physicians professional identity can become closely I would think closely tight to being those things.

00:06:55: What happens to the identity when you give up those roles?

00:07:00: The identity stays the same, but focus is changing.

00:07:05: so what I've been doing now...I took on a job for the Amsterdam UMC Foundation.

00:07:12: So we're trying get money from everywhere and that's an interesting thing.

00:07:18: And i have some other smaller teaching teaching nurses or teaching young doctors, etc.

00:07:25: But it's a little bit... I cannot just walk in and say okay do you have a job for me?

00:07:30: So they will call me.

00:07:32: if like what i'll do They will call again And If don't like it It would not call anymore.

00:07:37: On the other hand I had two nice racing bikes.

00:07:40: A beautiful bike.

00:07:41: You get more time For other things.

00:07:44: That's amazing.

00:07:45: Sounds like you've created an ideal transition from one chapter to another?

00:07:52: Yeah, I think.

00:07:53: looking back also the fact not staying in Amsterdam until the very end but actually going abroad which was a nice opportunity Which maybe not everyone had.

00:08:02: But i think it is worthwhile to look for kind of an opportunity What we should not do as chairs at this apartment.

00:08:08: We shouldn't stay till that last day and then close the door because then the whole department doesn't know what's going to happen, etc.

00:08:16: So I think even if i would have stayed in Amsterdam ,I actually offered my designation five years before but there was a merger and two years ago I repeated it and they agreed okay its'a good time!

00:08:30: And new chief started at a clean apartment .

00:08:33: I knew him very well.

00:08:34: he is a great friend of mine away anyway, but it's nice to go abroad and was a fantastic experience living in that different country for like two years.

00:08:47: What you're saying I guess is that good guest knows when to leave the party?

00:08:52: Yeah!

00:08:53: Good point.

00:08:54: So how do know... When this time and where is difference between being needed your mentorship or advice and you're wanting to be needed, although... You've raised already self-sufficient physicians who can handle their own.

00:09:16: Those are important questions that are difficult to answer.

00:09:19: I think we have seen especially in endoscopy and endoscopic ultrasoundography tremendous new developments And the way we've done it in Amsterdam also in New Zealand is always work with two or three physicians together, if we can.

00:09:37: Because in the beginning those procedures were very scary actually because there are complications and all that... And I think If We Work Together With Three Of The Physicians Sometimes In The Same Room Then Actually It Was Normally To Rotate And Say Okay Today You're Doing it Next Day I'll Do It Etc.

00:10:00: So Its Not That you should kind of say, okay I'm the most experienced and i will do the procedures until i go away.

00:10:09: I think just teaching and nurturing etc.. And every procedure has a sometimes very scary area... Sometimes it's actually quite an easy-going area.

00:10:20: you can hand over an endoscope to see if this part And I'll be watching and then if everything goes well, you just continue.

00:10:29: If there's a problem we will discuss whether we can do like this way or actually give the other scope back to me?

00:10:36: Although sometimes it is nice go for cup of coffee.

00:10:40: that isn't really teaching.

00:10:42: You should stay where they are in every thing going as well.

00:10:46: but don't try.

00:10:48: make things good make things better, that already are good.

00:10:52: If things were going well just relax.

00:10:55: but it is different difficult at times

00:10:58: Yes and you're talking about very advanced almost surgical interventions And its becoming more dangerous.

00:11:08: It's not a simple gastroscopy And I do remember we talked a lot about teaching and mentoring, but also read famous neurosurgeon Henry Marsh said that biggest mistakes came from teaching an overestimating or underestimating his trainees.

00:11:27: So how do you feel like where's the balance between our responsibility to the current patient?

00:11:35: That on the table trusting with their body And to the future patients of the trainee that you're trying to train?

00:11:45: Yeah, I think it's not as black and white as maybe a marsh soil kind.

00:11:50: Okay now You'll give into the youngest doctor and see if...I Think If you do kind of even training.

00:11:57: so if your work together

00:11:58: So It

00:11:59: probably goes wrong in surgery.

00:12:01: if you get surgery is an example.

00:12:04: if The start of this surgery has been done And the professor says, okay I'll go for coffee and call me if there's a problem.

00:12:11: As long as you work at Justine i think You can do things very well.

00:12:16: Yeah...I don't think it is that black-and-white.

00:12:21: The other thing here Is training costs time Costs time For the trainee Also for the trainer Because the trainer should not be working in the room next door and only be available, then there is a problem.

00:12:34: I think it's really these things were like you said endoscenography therapeutic endosynology was quite scary.

00:12:40: at first time before we did that procedure We talked to our surgeons because they knew if he would make a hole somewhere And we wouldn't need to call the surgeon.

00:12:50: The surgeon is very happy but doesn't want him never heard about a procedure etc.

00:12:57: So I think that's also interdisciplinary.

00:13:00: Corporations are very important in these kind of new techniques,

00:13:04: so it's also a little bit if you're building a team is like building system of checks and balances?

00:13:10: If one part falls apart then you can count there as another safety measure between catastrophic results.

00:13:19: Yeah!

00:13:19: You should tell the surgeon to do procedure on Monday but you tell him it is in advance so that he's aware and can actually help, probably doesn't need to come.

00:13:34: If we do this way... He will say okay, unfortunately happened

00:13:40: etc.,

00:13:42: if I just call when he leaves the hospital and hears about a verbal complication then things are well.

00:13:50: relationships are broken.

00:13:51: i think

00:13:52: It gets more tricky to solve those.

00:13:56: So, Paul.

00:13:57: You left a comfortable European atmosphere where you were giant for a Hobbitland and in the sense that you are new kid or person.

00:14:11: what did this experience teach about yourself?

00:14:15: It's a new situation but I think we have to work our way up through it.

00:14:22: The nursing staff is probably one of most critical ones not vocally critical But they know exactly what they see.

00:14:28: And if you just come in and say, well here I'm from Amsterdam and now we do it like this?

00:14:33: Oh yeah that's a small hole but no that's not the way to do it.

00:14:36: so i think relationship with nurses is probably very important because you need them Not during the entire procedure sometimes but you'll meet them.

00:14:45: They have seen many people performing procedures So they can also help your reputation.

00:14:53: They know what is up and when things are not that top.

00:14:59: After leaving, since it was gradual and still you're active in other roles but... Is there something that you miss?

00:15:07: That you did NOT think that you would miss after leaving active clinical

00:15:11: duties?".

00:15:13: Yeah I think one thing i missed..I worked quite large where there was a big social interaction, I think.

00:15:23: And the work-life balance is different in New Zealand like I already said and one of their reasons that they do have to leave the hospital which it's completely fine.

00:15:33: It's just why not?

00:15:34: Why should you say if they had to stay they would etc.

00:15:37: In Amsterdam typically we add still some other meetings early morning or evening.

00:15:42: There were little bit more social interactions on the other hand really something that I missed it, but that's more a personal thing because there was a big team which i was very fond of.

00:15:56: So you miss the actual people rather than particular aspects?

00:16:01: Yeah!

00:16:02: And the attitude between probably in the Netherlands is quite equal.

00:16:10: if a nurse sees and says well not sure that's equality everyone will definitely listen etc.

00:16:18: Maybe you seem to do a little bit more hierarchical, but not that much.

00:16:23: There's always difference between the different doctors.

00:16:26: Fair enough!

00:16:28: And it has been two years since we last spoke and there was some time for reflection... Having had this fruitful incredibly successful career of course took a lot of dedication and time from your family Now that you have time to consider things, where are there unexpected costs?

00:16:55: from today's perspective might not be worth it or just costly?

00:17:02: It is a good question.

00:17:03: And I think normally what we should try and of course your talking about my own social environment as well... ...and i was flying around the world quite alot.

00:17:12: so yeah..it took some time etc.

00:17:14: but on the other hand thats something.

00:17:17: It's because at home as well.

00:17:19: Because you should have kind of, especially I think in nowadays... You don't expect the man to just leave the home at six in the morning and come back and see his food on the table?

00:17:30: I think we are way beyond that!

00:17:32: Hopefully!

00:17:34: Yeah No, but I think you should take your wife or the children out to dinner regularly and have good discussions about that.

00:17:43: Because if you just stay home sometimes there are so many other things.

00:17:48: So for me what would help is go through the pizza joint close by get a pizza and discuss everything And leave your phone behind for couple of hours.

00:17:59: That's great advice!

00:18:01: And talking about advices two years ago You advised having or dedicating some time just to wonder and explore.

00:18:10: Talked with people, get inspired... Is it still the same after your journey there?

00:18:16: And back again?

00:18:18: Yeah I think not.

00:18:20: that much has changed.

00:18:25: No!

00:18:26: Two years, to wonder.

00:18:28: Yeah

00:18:28: and it was two years in a completely... It's quite nice to do that together with my wife because you are in an completely different country where when we start very little social context the neighbors on this side but otherwise everyone goes home relatively quickly which is completely fine, and they're very social.

00:18:52: They go out in the weekends.

00:18:54: They always go hiking with group of friends

00:18:56: etc.,

00:18:57: so take care all their social activities.

00:19:00: And I met on different hikes where we did like again cross-colleges et cetera... ...and everyone always was a family.

00:19:09: yeah it's a very nice way of work like

00:19:15: that.

00:19:15: Oh, New Zealand sounds better and better by each sentence.

00:19:20: Professor thank you so much for your time all the time in your career for things at UG and being such an inspiration.

00:19:30: Thank You!

00:19:31: Well thanks for having this talk.

00:19:33: I don't think that we will come back again two years but you are more than welcome But i think it's getting a little bit long.

00:19:38: So let us conclude here

00:19:42: Or we await unexpected journeys that can follow up on.

00:19:46: Okay!

00:19:49: Great, thank you for your time and thanks everybody for tuning in.