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Step up, be brave, and make a difference. Powerful calls to action from medical leader

Introduction by Croakey: After making his mark as a strong advocate for health equity and systems reform, public health and climate action, the outgoing president of the Australasian College for Emergency Medicine (ACEM) has expressed his frustration and anger at the “idiotology” of political leaders who deny the impacts of climate change.

Dr Simon Judkins also told #ACEM19 participants in nipauluna/Hobart today it is “shameful” that two wealthy countries like Australia and Aotearoa/New Zealand waste resources on unnecessary care and interventions of low-value while vulnerable patients suffer.

He also urged Australia “to take a lead from our cousins across the ditch and demand leadership which is caring, empathic and civilised”.

The Australian Government was, he said, “ignoring the plights of many, denigrating, belittling, detaining and arresting those who dare to publicly voice their concerns”.

His (lightly edited) speech follows in full below as part of the Croakey Conference News Service coverage of #ACEM19.


Simon Judkins writes:

Over the past two years, the College has evolved and changed in many ways. Our role has expanded, our advocacy has grown, out voice is being heard, both in Australia and New Zealand, but also in many other parts of the world including all the work we are doing in the Asia-Pacific.

Our Constitution has changed. Our Board has changed.

We have consumer representatives on many of our governance bodies and committees.

We have new faces in College entities… in fact we have new College entities, aiming for a balance, reflective of our membership.

We have a Pre-hospital and Retrieval Diploma..almost. We will, hopefully, have Toxicology. We have Advancing Women in Emergency.

We now have a New Zealand President Dr John Bonning. I wish we had the NZ Prime Minister… but that’s not likely to happen anytime soon.

We have GECCO, the Global Emergency Care Committee. We are working in PNG, the Solomon Islands, Fiji, Vanuatu, Sri Lanka and many other places.

We are championing mental health, system reform, clinician wellbeing, inclusion and diversity…and climate change action.

We have “your ED” magazine. We have more Fellows in more parts of the country in Australia and New Zealand than ever before.

Big challenges

But there is much more we need to do.

There remain significant challenges for Emergency Medicine and the wider health system in which we work, and which we will continue to advocate. When I first put my hand up to be President, I had my ideas, my views about where I wanted to take ACEM. My primary goal was to ensure the work that we would do would be work that we would do together. Us. As a College. As a team.

That is one of our greatest strengths – as emergency physicians, we know how to work as a team, to run EDs, to save lives, something that few understand or have experienced.

We act in the common interests of our patients and supporting each other to work as one.

I urged us all at the time, to step up, take charge and effect change. That we be an organisation that leaves no one behind so that we can go from strength to strength. I’ve advocated, as best as I could, for patients, for colleagues, for our profession from that position as President.

We, as Emergency Physicians, are in a privileged position.

I know that this is sometimes very hard to recognise when you are in the middle of a busy nightshift. Or a busy weekend and you’ve just come on to 30 patients in the waiting room, ramped ambulances and patients in corridors awaiting inpatient beds.

I know, I’ve been there, I’ve done that, and I still do…but we have an opportunity to influence the agenda and to change the public narrative.

We have the opportunity to change people’s lives, to save people’s lives. There are not many jobs that can offer that.

So, the core values: Respect, Integrity, Collaboration and Equity, are there to help remind us about why we have chosen to be Emergency Physicians.

We are a specialty which embraces those values…or at least we should.

Questions to consider

So, one of my challenges to you is, when you leave here and go back to your ED, sit down with your team and reflect on a few things:

  • Are patients with mental health problems listened to? Or are just they labelled as “frequent flyers” and left to wait in the hope that they may get to leave?
  • Are Indigenous Australians and Māori recognised and acknowledged? Do they feel culturally safe in your ED? Are you working with them to improve this?
  • When was the last time you took one of your colleagues aside and called them out that their “flippant remark” was not a joke? That it was sexist or racist and discriminatory? How will you address bad behaviour and bullying in your hospital?
  • Are you working with your LGTBI community to understand their needs?
  • Has your leadership team been the same faces for the last 10 years? Is it time for a change?  To increase both gender and cognitive diversity.

There are many more questions, but you get the gist – right?

We all need to walk that walk to be better, to be the best that we can

And I’ll openly admit to you that I still have much to do to get this right.

But you are the strongest advocate your patients will have, the best support your team can have. Your efforts, your contributions matter.

I was asked about my legacy, my achievements recently. I said that it wasn’t for me to decide and judge what it would be.

All I’ve really wanted to achieve was us working together on issues that matter to our patients and to you, to advocate for our patients…to speak out together on improvements and resourcing for our emergency departments in Australia and New Zealand, and to improve our health system.

If I could play a small part in supporting and inspiring a new generation of leaders in this career that I love, what could be better?

So on that note, I want to talk to you about where we’re at right now and what the landscape looks like right now. Because we need to pull together as a team and bring our communities along with us to help us get the best that our patients and staff deserve from our system.

Shameful waste

Because what is continuing to happen in our health systems is extraordinary for first world countries, in spite of our efforts to raise the alarm as the canary in the coal mine of a very stressed health system.

We continue to see the ongoing under-resourcing of EDs and hospitals.

We see system dysfunction.

The lack of coordination of our health systems.

And the harm this is causing patients and the mental anguish and stress this is causing staff.

For two countries with vast resources, it is shameful that resources are wasted on unnecessary care, on interventions of low-value; wasted resources while vulnerable patients in our communities suffer.

That we waste those resources in providing subsidies to private companies who take their profits off shore and pay no tax while waiting lists in hospitals grow, access block worsens and elderly patients and patients with mental health issues spend days in Emergency Departments.

Resources are wasted while the gap grows in Indigenous health, while homeless rates climb, while suicide rates are still high, domestic violence remains unchecked… we discharge people into homelessness.

We have seen the plight of regional communities…suffering from lack of medical resources and now, frequently and obviously being impacted by climate changes with bushfires, floods and droughts; the tragic events of the last few weeks are witness to that.

“Disheartening and frustrating”

It has been disheartening, frustrating, infuriating  to see political leaders seemingly ignorant, through ideology or idiotology, denying the links between climate change, the worsening drought, the catastrophic fires and the subsequent enormous impacts this is having on the physical and mental health of those impacted communities…in fact, on all, including our children. And we heard Helen Berry talk to that earlier in this meeting.

Meanwhile, in NZ, while impacted by similar issues of overcrowding, worsening access block, there is a political leadership which has a level of awareness, inclusivity and progressiveness which is the envy of many Australians.

I do recognise that NZ still has much to do to see equity and fairness for Māori, who still suffer the huge impacts of colonisation.

But in my visits to NZ, I was struck by how far we have to go in Australia to see the plight of Indigenous Australians elevated and addressed at a national level, as they clearly are being across the ditch.

We have seen those most vulnerable, refugees seeking a better life, stranded on islands off the Australian coast. Not welcomed here and not welcomed there…although, again, New Zealand has stepped up.

I have been incredibly impressed by the role many FACEMs have played in advocacy and the position ACEM has taken on supporting the Medevac legislation.

We have seen children suffering and distressed as they have been moved out of their homes, places where they were born and raised, in a cruel attempt to deport them back to countries they have never known…this is their home.

And Sudanese youths in Melbourne targeted by immoral politicians in a game of political point scoring.

We see climate change activists arrested for caring about our future, be careful on Thursday [referring to an ACEM march through nipaluna/Hobart], while multinational conglomerates destroy our environment, with decades of knowledge about the impacts of their actions, moving their profits offshore and minimise their taxes…taxes which could be used for the betterment of all Australians.

We see vulnerable people needing our support, those who aren’t able to secure employment, being branded as drug-addicts, not worthy of our help.

And our healthcare systems increasingly divided between the haves and have nots, with the health gaps widening, but somehow, with the help of generous government subsidies, money is being made by private providers who provide substandard care and profits are being moved to minimise taxes.

And we see reform of our health systems, particularly our hospital systems, obstructed by those with self-interests and a desire to maintain the status quo, as it is better for them as opposed to the betterment of the health systems, we work in…and better care for our patients.

So, you can see, I’m angry. I am frustrated. But with that, I remain determined and resolutely optimistic.

I am proud of what we have achieved as a College, as Emergency Physicians, all staff who work in EDs. I am proud of the core values we carry, Respect, Integrity, Collaboration and Equity.

Nye Bevan, the driver/ creator of the NHS said, “No society can legitimately call itself civilised if a sick person is denied medical care because of lack of means.”

Well, our society is being challenged right now.

With refugees on Manus and Nauru, with vulnerable patients being unable to access the care they need, with increasing levels of homelessness, people with mental health and addiction problems waiting in EDs for days, Indigenous Australians being deprived of basic health needs, inequities in care for Maori, we need to ask if we are, in fact, a civilised society.

And we have a Government who seems to want to make it even harder…ignoring the plights of many, denigrating, belittling, detaining and arresting those who dare to publicly voice their concerns.

We do need to take a lead from our cousins across the ditch and demand leadership which is caring, empathic and civilised.

Reasons for optimism

What has kept me positive and optimistic is you people. The people in this room who are working in EDs across our two countries. Those people who have engaged, who are building a force to be reckoned with. Who are increasingly uniting around a common goal.

Challenging the status quo, reaching out to their communities, advocating for the rights of patients to access the care they need, providing vocal support to patients who rely on our EDs and public hospital systems, advocating for better primary care, better mental health care, fairer systems which embrace equity, access, social justice, inclusion and diversity…standing up and doing what we, as doctors should be doing…ensuring we act with and for our patients, our society to make our world a better place.

As I pointed out at the beginning of this, there has been a lot of positive change over the last two years, and that has been driven by all of us… driven by you.

The most important measure of my success as President is what you do now.

There is only one thing I care about with respect to a legacy;  how I will judge the last two years, if they have been a success. If you walk out of this room, leave this conference and think to yourself, “screw it, what’s the point…” – then I have achieved little.

BUT, if a few of you leave Hobart, and think, “ yes, I can do more…I can get involved…I can make a difference….” and decide that the status quo isn’t acceptable, decide not to accept the world as it is and get cracking on changing it…one step at a time, from smiling and saying hello to the night medical registrar when she comes to the ED, or sitting and listening, really listening, to your patient as they explain why they feel unsafe to go home, to making a decision to join an ACEM committee, become an examiner or, and hopefully there will be a few of you in this room, thinking, “I can do what he did, become President and do it bigger and better..”

Then I will have made a difference.

Ultimately, that’s all I wanted to do. To make a difference. To encourage people to be the best they can. To play a small part in supporting and inspiring a new generation of leaders in this speciality that I love. What could be better?

Call for courage

Do I have any regrets? Yeah I do, and I think that will become more evident with the passage of time.

Right now… I wish I had been braver.

Braver from the get-go… to challenge more, to push the boundaries, to demand change. I would encourage all of you to take every opportunity you have to step up, be brave, make a difference.

Two years goes by very quickly…I’ve got a year to go as the Immediate Past-President, so I reckon of got an opportunity to step things up things a little bit more. So, as I said, you won’t see the back of me just yet…

• This presentation was slightly shortened in editing.

From Twitter


The 2019 ACEM ASM is being held in Hobart from November 17-21. Amy Coopes is there for the Croakey Conference News Service. Follow @coopesdetat, @acemonline and #ACEM19 for all the latest.

Read our previous ACEM ASM coverage here and here.

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