Being Well in Difficult Times - Margot

Dr Margot Woods is a GP in Sydney’s Inner West and Discipline Lead in the Dept of General Practice at the University of Notre Dame, Sydney. When I asked Margot the “3 big questions” she generously recorded her answers for us to listen to. There’s a transcript of her recording below that’s been slightly edited for length and clarity.

Margot has a refreshing approach to life’s challenges, and I think there is something very valuable to be found in her perspective on our current dilemma.

“What are your biggest concerns about the pandemic?”

Certainly, at the beginning of the pandemic, my biggest concern is how bad it is going to get and how much will this impact on everyone? Everyone I love - my family, my practice, my patients and of course, my students that I teach - so it’s kind of everybody.

I grew up knowing my grandmother as a child had lived through the Spanish flu. I heard many stories about the Spanish flu and how devastating it was, how many millions of people (I think it was 20 million people) died in a time when the World War had just swept through and killed so many of the young men and the impact that that had on the world as a whole. So, I guess I had always known these things can happen. And certainly, in epidemiology lectures, I'd been told that we were well and truly overdue for a pandemic.

The reality of it was shocking - how quickly it seemed to happen. There'd been little hints over the last couple of years - and then it felt like a tsunami that arrived. Those were my first thoughts, and also, are we ready for something as traumatic as all of this? For me, being medical, my main issues were reading about the medical side and how it was likely to impact on everyone. But of course, there’s the economic side, which is something I'm not very knowledgeable about, but it has had a huge impact, obviously, on the economy and directly back on patients, based on that first few weeks.

I had so many patients who had actually lost their jobs, and patients who had huge impacts from it on every level. So that was the biggest issue for me, our biggest concern when it first started.

What have you been doing to help keep your anxiety about the pandemic under control?

Looking back over those first couple of weeks, the first thing for me was that I really I needed to make sure that I had my source of truth, that I had really good, reliable information and that didn't take me long really at the beginning to find. There was a tsunami of information - too much coming at me and it was hard to digest it all. So it became really important, to locate the sources of information I could trust. To find where I could put my feet down and feel some solid ground, rather than feeling that it was completely out of control. For me, those places were things like the Ministry of Health and the CDC. After a while, I decided that the best place for me to look was at the daily updates that came from the College of General Practice, because they gave me all the insights into what the figures were and what the advice was. And that information was then translated into Health Pathways, which is all over Australia. It gave me local information such as what testing options I've got in my area and where do I do it. So, my first thing is to find solid ground to stand on. The second one is how do I block out all of the other chatter?

Social media is really not a helpful place for me at all. I don't want to look at Facebook. I don't want to look at conspiracy theories. I don't want to look at misinformation. I guess it took me back to 9/11. I remember hearing about what had happened when I was at a walk down in the park, down on the harbour in Balmain at dawn. I was totally shocked. I came back. I had young children at the time. When they got up we watched the vision that came out of New York that day. It was so horrific that I turned the television off for the next two weeks because I decided, mostly for the children, that they'd seen the images, they knew what had happened, we didn't need to actually keep looking at that same thing over and over again and re-traumatizing ourselves. So I guess I went back to that idea. I don’t need things that are unhelpful. I need to know what I can trust.

For me it's been a time when I've really noticed who are our leaders, who has actually helped us get through this. And I mean, I guess they've been political, but also probably for me more medical. Who do I look up to? Who do I trust? Who has kept calm and helped? That certainly has been a number of people in my life, both locally and certainly broader than that. So finding those people comes hand-in-hand with where do I get that good knowledge? Trust.

The second thing for me is that I've always been a change embracer. I find change generally leads to improvements, even if not initially. I find change quite challenging and exciting. I know that's not universal, but I guess for me that this time, when we have to adapt and we have to change, allows my mind to be as creative as I can. And to accept that as we make changes, we make mistakes but being willing to accept that and say, “well, that didn't work, let's try this.” For me that process is something I've done for many years, particularly in medicine, in running practices and learning how to do things better and I find that quite an exciting challenge.

We've had to make these changes that have been absolutely forced upon us. But I guess I've allowed myself to agree. “Okay, let's be creative. Let's accept it.” And the main message too is “let's be compassionate if we don't do it right”. I look at those mistakes as learning and “let's try something else”, “let's put that aside, move on”, “Let's not beat ourselves up or beat others up”, “let's all try and work together to try and see if we can make some better improvements”.

I do think that during this time, there are some things that I feel that we've been very lucky with. Things like tele-health, which I think has been well and truly overdue. We've got that now. I mean, yes, we suddenly had to do it overnight. And we're learning on the hop. But I'm hoping that some of these things that we have turned to now will stay, maybe the electronic prescribing, how long have we waited for that! There will be things that come out of this that I hope we can keep and hope we can use moving forwards.

I guess the big thing is being compassionate to yourself and being compassionate to others, looking out for each other, even just around the practice, and making sure that we appreciate the increased loads on everybody there.

The one area that really jumps out to me is reception. They have been really under the hammer at the front line with some distressed patients and a huge extra workload that's come from a lot of this tele-health and bits of paper and things. I’ve tried to reach out to them and helping, looking at how we support each other and how we might be able to do things a little bit better.

One of the other things for me is being able to take a bite of what I can manage and not looking too far ahead. So, looking at, okay, well, what can I do with the knowledge? I've got my good knowledge now and I've got my who I should test and how I should deal with this. So, what do I do today? What changes? What things? How do I adapt with things that I'm doing today? If I try and think too far ahead I think about my grandmother story, about 20 million people dying. It's not helpful for me. It's all I can do is go “Well, I can't fix that”, but I have to look at what I can actually do today, because otherwise I would feel really overwhelmed. So there's small bites and small things that I feel that I can then almost feel that I've achieved something today.

Okay, I've done all that and it gives me a sense of control. Looking back to my personal values would come into it too. A large part of my personal values and my role in life is being a carer and we can really step up into that role at this time and really reach out to family members and friends and, of course, our patients and try and give them some of that solid ground that I feel I have I've tried to create for myself. It's been an interesting time.

One of my Aboriginal patients gave me a bit of a lesson when I tried to explain to her that I know I'm getting my knowledge this way and that makes me feel more in control. And she just looked at me and said, “Well, I guess that's the difference between you and me.” I said, “What's that?” and she said, “Well, you trust the government.” For me, it was yet another lesson that the trauma in many people's backgrounds and particularly disadvantaged groups like Aboriginal patients who really have no reason to trust the government, they haven't done well by some of the things that have happened in the past for them. It made me look at myself and think, well, what a lucky person I am to have grown up with an ability to be able to find that solid ground and a sense of control where many, many people may not.

One of the other things that was helpful to me is really looking back and being aware that I have survived in the past. There have been some black times in my past - perhaps not as black as for others. Times where I've had loss and felt like the world really was coming to an end for me - and I survived them. I was very traumatized and damaged during those times, but when I look back at them (I wouldn't suggest recommend anyone going through them) they have meant that I've grown as a person and become more understanding and I guess a better person for it, which sounds all a bit trite. But the fact that I have managed to survive before and come out the other side, gives me a sense that we will all be able to do that again.

One of the other things that's come to me very much is this whole concept of social distancing and how important it is that I think we should change the name to physical distancing. That's what we're supposed to be doing. I think that we should be socially close and physically distant.

Do you think the experience of this bit of history will make a difference to you and your plans in the future?

Absolutely. I don’t think anything will ever be the same after this. I mean, I'm hoping that we get the vaccine and we get it under control and we look back and this is a little bit of history, as you've said.

Another part of me feels that perhaps it never will get under control and that this is our future, that we will get it under control to a certain level, but not to the level where it's a coronavirus free world, unfortunately. I think we may live with recurring epidemics over time. And I guess it's really going to make a huge difference to the way we practice medicine, the way we live socially, and our economy. And I guess, will it change our values. Will we all decide that we need to shop as much, travel as much, interact as much? I don’t know.

I don’t think that we will ever be the same. We will learn a lot of lessons, some of them difficult lessons. And some of them, as I said, might be progress towards things, improvements such as the tele-health and maybe different levels of relationships than we’ve had before.