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Let's Have a Chat
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Transcript
Introduction and Trigger Warning
00:00:00
Speaker
Hey, this is Aidan and you're listening to another episode of This Might Sting. I just want to flag before we start the episode that we're going to be discussing some pretty heavy themes including suicide and death. And if you're someone who's feeling affected by this or a bit distressed, please reach out for help.
00:00:14
Speaker
Somewhere you can go is Lifeline Australia on 13 11 14 or you can Google Lifeline and there are a bunch of resources including a text and chat option.
00:00:25
Speaker
Thanks so much and enjoy the episode.
Guest Introductions
00:00:28
Speaker
Welcome again to This Might Sting. My name's Julie McCrossin and this is a program all about health that is based on evidence and ah passionately concerned about every aspect of health and wellbeing. My co-host is the marvellous Dr Aidan Barron who's here with us as well.
00:00:45
Speaker
And welcome to three of our listeners who are going to tell us about health topics they have an interest in.
Health Topics Overview
00:00:52
Speaker
And we may take up some of these topics at greater length in the future But welcome to Shona Edwards, who's living with the impact of proton therapy for a tumour on her spine that was treated with proton therapy.
00:01:05
Speaker
She's a cancer and disability advocate and most interesting of all, a classicist, studying the classics at the University of Adelaide. Welcome also to Alice Wolf-Nuke, who's finishing up philosophy.
00:01:18
Speaker
at to the University of Melbourne and she has a great interest in health and health journalism. And welcome also to Shannon Beresford who's a death doula and you'll hear all about that.
00:01:29
Speaker
An important guide at any aspect and time of our life. And we're going to do an amazing array of topics, attachment theory, polycystic ovarian syndrome, planning for end of life.
00:01:42
Speaker
preventing and managing burnout among healthcare clinicians, but also carers and patients themselves. And we'll take a look at the distressing level of suicide and thoughts of suicide among men, especially young men in Australia.
00:01:56
Speaker
we're going to kick off I think Aidan with Shona Edwards and Shona, despite the fact cancers have been big part of your young life, you want to talk about
Attachment Theory in Healthcare
00:02:07
Speaker
attachment theory. So can you tell us what you're interested in and its connection to health?
00:02:12
Speaker
Sure. So this is something I've seen come up on my social media feeds quite a bit lately. mostly in connection to analysing romantic relationships and also a little bit of our relationships to our parents.
00:02:25
Speaker
My understanding is attachment theory is a cycle psychology framework that talks about how our relationships with caregivers in our developmental childhood phases impacts our behaviour now And I'm really interested in it from a healthcare point of view, basically how our past can be a part of regular healthcare care that we're not really thinking about in those terms just yet.
00:02:50
Speaker
So I'm wondering about how people can learn how to be emotionally secure, how we can feel fulfilled, how we can get our needs met and learn how to deal with healthy conflict and basically how to build self-esteem.
00:03:05
Speaker
And I think, Self-advocacy has been a big part of your life as a young person with cancer. And I think you come from a family where your parents have split and each married someone else. So you're often in rooms discussing your health with four adults on yourself. So just getting eye contact with the doctor was at times...
00:03:24
Speaker
challenging. Is that issue of how to advocate for yourself without feeling worried about irritating the doctor, is that also connected to this attachment theory? Yeah, I think it absolutely is because the way that you understand yourself and your relationships to others, but especially your relationships to those people who are close to you,
00:03:45
Speaker
Of course, that affects your mental health throughout childhood and then adulthood. But how you interact with, as you say, doctors, how you even interact with the healthcare care system. I'm thinking about it from the perspective of young women and young people in general, trying to have some confidence to raise the issues that they think need to be addressed.
00:04:06
Speaker
And the insecurities we might have because of our pasts or because of how we've developed around dealing with authority, questioning perhaps what our doctors might be telling us and pushing to get things addressed that we might be generally getting a message from society that it doesn't matter, it's a small issue, you'll get over it.
00:04:25
Speaker
All those kinds of things that can really underline our already present insecurities. It's a huge factor in how we access healthcare.
Shona's Cancer Journey
00:04:32
Speaker
And just remind us, how old were you when you got your cancer diagnosis and how old are you now?
00:04:37
Speaker
I was 23 when I was first diagnosed. I'm just about to turn 30 For me, it was as a young adult, I was just starting to develop my career.
00:04:48
Speaker
i was hoping to finish my education and then cancer came in, disability came in So it was a huge rupture to what I thought was the expected development of my life.
00:04:58
Speaker
So those impacts can't be taken for granted. And just for but to be clear, your disability, you do use walking sticks and at times a wheelchair, is as the result of the treatment that kept you alive.
00:05:09
Speaker
Absolutely. It's a little bit treatment, a little bit progression of a cancer and a little bit of, yeah, just the impact of surgeries and how violent cancer treatment can be on the body. Well, Aidan Barron, trust and communication so important.
00:05:23
Speaker
And I've never thought of it in relation to attachment theory. What are your thoughts on it?
Understanding Attachment Theory
00:05:28
Speaker
I just want to acknowledge, first of all, Shona's insight into what is such a profound aspect of the interaction. And in fact, you'll be pleased to know that there's a great study out of Denmark that that actually examines attachment theory in the relationship between doctors and patients um that will pop in the show notes.
00:05:49
Speaker
I think you're spot on. And I just want to praise, one, your insight into this issue. And also thank you for being able to share with us your journey so far. If we're talking about attachment theory, it's probably worthwhile just giving a brief sort of description of it. It was first posted by John Balby and then Mary Ainsworth is the goddess of attachment theory. She did this experiment called the the strange situation where she took a bunch of young children. And when I say young children, I'm talking toddlers and pop them in a room with their parents and then, or a guardian, then the parent guardian leaves the room.
00:06:23
Speaker
And the researchers observed how the child behaved. And then we brought the parent back into the room and saw what happened. And basically what Mary Ainsworth and her research team found is that there are essentially three or four kind of responses that children had.
00:06:40
Speaker
There were those who had a secure attachment where the caregiver was in the room and they played freely. The caregiver left the room and they kept playing freely and the caregiver came back into the room and they were like, oh, hey, my parents back. This is so lovely. Hi, let's keep playing.
00:06:54
Speaker
Then there were the kids with anxious avoidance or insecure attachment issues where they were playing, they were quite clingy to the parent. The parent left the room, the caregiver left the room and they became distressed.
00:07:06
Speaker
And when the parent came back into the room, the caregiver came back into the room, they clung to the parent. That's the sort of second kind and it's what's probably most common for us to see in the community.
00:07:17
Speaker
Then there's also those with with an anxious, ambivalent or resistant, insecure attachment style where the caregiver
Doctor-Patient Interactions and Trust
00:07:24
Speaker
is in the room, the child's playing, the caregiver leaves the room and the child becomes distressed.
00:07:30
Speaker
And then the caregiver comes back into the room and the child goes, no, you rejected me, so now I'm rejecting you and avoids the caregiver. And then the last one is category four, which is lumped in everyone else. It's an ambivalent sort of attachment style.
00:07:45
Speaker
And now the psychology has come a long way. And in all things psychology, we use things which are models. They're ways of understanding things and explaining things. But essentially at its core and attachment theory says the re ah relationship you had with your caregivers at an early age impacts the relationship that you have with other people as an adult.
00:08:05
Speaker
And it's not ah it's not a long bow to say, hey, the relationship that you had with a parent as a young person is likely to influence the relationship that you have with a doctor who's in a position of authority when you're sitting on the other side of a table from them as a young adult or even a mature adult.
00:08:22
Speaker
And I think you're absolutely right. And the literature supports you that that bears out, the the proof is in the pudding. And we see that every day. And it's interesting because we spend a lot of time as clinicians being reflexive and thinking about how what we bring from our own life experiences can have a negative impact on the relationship with patients. And we create often a wall or a barrier, and we are very selective with what we do and don't disclose because we don't want it to impact on the relationship with that we're having with patients.
00:08:56
Speaker
And for better or worse, We don't ask patients to do that often, which is to think about what they're bringing to that relationship. And an interesting discussion we had in one of our previous podcasts with Millie Weaver from the Australian Endometriosis Foundation was this discussion around how particularly young women with endo who've had a lot of potentially traumatic experiences with healthcare providers can come to the table and have had so many negative experiences previously that the first time few moments of the interaction is quite, and I don want to be very careful with the word I use here, aggressive.
00:09:32
Speaker
And I, as a doctor or as a health professional, can sometimes feel like I'm under attack because in an effort to try and get help from me, the first thing that this person in front of me is saying is, and this doctor did this, and this doctor did that, and this doctor did that.
00:09:50
Speaker
And that's happening more and more. Because I think as a healthcare system, we're becoming under strain and probably unable to meet people's needs and expectations.
00:10:02
Speaker
Shona, I wonder what you think about what I've just said. Yeah, I think it totally rings true to me. I think it can be really hard when you've had a long history of chronic illnesses or even just rare diseases where your healthcare needs weren't met to then address that again. And I'm really interested in how we can better support both sides of that relationship to ensure that people can raise things again if we have to, so that we're not just one and done dealing with a previous traumatic experience.
00:10:34
Speaker
We're trying to reopen that safely and get the care we needed then and that we need now. I think that's the thing about attachment theory for me is it's about how the past defines us, but also about how we're coping now.
00:10:47
Speaker
Yeah. Could I just bring in Shannon Beresford, our death doula at this point, because he's dealing ah regularly with clients who have had a very serious or even ah a life-limiting diagnosis.
00:10:59
Speaker
And I just wanted to show, in your response to this topic, is it something that... makes you think about how some of your clients are dealing with the health system? I completely resonate with this, Julie, because I see some of these challenges in the end of life space in particular.
00:11:16
Speaker
And when you've got multiple clinical others coming in for support in and out, it yeah and certainly applies in that space as well. but One of the things we're going to do shortly, Shannon, and also Alice, just to give you a warning, is to get any one or two tips from your own experience for dealing with health practitioners when you're trying to have perhaps difficult conversations. But if I could just come back to you, Shona, for a moment.
00:11:43
Speaker
i Really, you're a very interesting person. I don't mean to talk about you like a specimen, but you are living with a great degree of uncertainty about your future and how long you will live or what sort of treatment may happen. You may wish to explain a little bit of that. but You ah have, ah like many other cancer patients, that fear of recurrence or fear of something going terribly wrong.
00:12:10
Speaker
On the one hand, we want to share it with our doctor and other clinicians to get help. But on the other hand, you don't want to be seen as overly anxious or mentally unwell. And it's because you want to be credible.
00:12:21
Speaker
So can just tell us a little bit about how you try to walk that path to get the help you need, but to still be seen as ah ah some sort of equal in the relationship?
00:12:32
Speaker
It's such a good question. I'm really glad to be on a panel with and everybody here because it is a huge part of my life, not just how I am at now with an inoperable tumor and no current treatment options dealing with that uncertainty. But even to get first diagnosed, I dealt with chronic pain for years before it was properly addressed. And I had to push for that scan myself, which found my tumor. and So I think a lot of us ask ourselves, how can I bring this up to my GP, my physio, whoever it is again, because I'm really worried that they might think I'm paranoid. and I think the dilemma with some chronic illnesses is that being paranoid pays off.
00:13:13
Speaker
Sometimes you actually do need to be on the lookout for changes. But at the same time, you don't want to be living in fear. So I found that it really depends on a relationship of trust with my clinicians in general, before we get to the point where I'm trying to raise an issue for the second, third or fourth time.
00:13:31
Speaker
And before I'm establishing something as a long-term fear of mine. We have to agree that there are things I know about my condition where I'm really familiar. I'm the expert on my own body here.
00:13:41
Speaker
So I think that's the dynamic that I would encourage on both sides is that recognition that a person is the expert on themselves. But one of the strategies I think you use is that you try to learn and use the technical language of medicine, something not everyone is capable of doing in terms of vocabulary and so on. But could you just explain what you seek to do and why you've taken that approach? And then I'd you know love to hear Aidan's reflections on that.
00:14:12
Speaker
Absolutely. So i think the temptation we have that to meet the doctors where they are. And there's pros and cons to that. If I go and educate myself and I learn the language of medicine and I come into a first appointment like Aiden's saying, it can come off pretty aggressive for me to come in and just start citing the literature.
00:14:32
Speaker
However, i have a rare condition. This is a rare type of cancer. I don't actually expect all of my clinicians to be the expert on it. So sometimes I think coming with that more researched a perspective is not necessarily intended to be hostile to the clinician. It's more of here's what I know.
00:14:49
Speaker
What do you know? Can we collaborate together? So I think there's a line to walk there of learning, doing some research, educating yourself, but also expecting that the doctor is going to have their own expertise and what you're building is actually something together.
00:15:04
Speaker
Your thoughts on that, Aidan?
00:15:08
Speaker
I love the way you've framed it as building a relationship of trust because that is the key. And it's about the longitudinal relationship of trust.
00:15:20
Speaker
That is where all the good things happen. And it's the the key of a productive patient and provider relationship. It depends on trust. I trust that you're telling me accurate things and you trust that I have your best interests at heart.
00:15:35
Speaker
And the convergence of those things is where I can then be vulnerable as a clinician and say, actually, I'm going to bring my own humility to the table. ah Please tell me more about what you know.
00:15:46
Speaker
And that ah when I trust you, it allows me to be open to considering other possibilities. And there's nothing wrong with citing literature and there's nothing wrong with educating oneself. In fact, most clinicians will encourage you to do so.
00:16:02
Speaker
um Making sure that you're getting it from reputable sources is, of course, important. So not TikTok, for example. The... The things that we feel scared about, and if you'll permit me to be a bit vulnerable myself for a moment, as a doctor, I'm scared about doing the wrong thing that hurts one of my patients.
00:16:23
Speaker
And I'm also scared about doing the wrong thing where I am looked at badly by the rest of my peers and I'm judged by my peers as having failed and not lived up to the standard of my profession.
00:16:35
Speaker
And so when a patient comes in and starts speaking negatively about all the other professionals that they've seen, That then puts me on the defensive because I go, oh no, what if they talk about me that way?
00:16:51
Speaker
I don't want to be the next doctor under fire, which is very different to when a patient comes in and says, hey, I've got a rare condition. I'd like your help. Here's what I understand so far.
00:17:02
Speaker
And then goes boom boom boom boom boom boom boom, boom, boom, through a list. That's not that's not a threat at all. That's amazing. That's the dream. Yeah. And I think it's that difference, which is to understand. And also want to preface just for a second that you shouldn't have to, as a patient, be doing the emotional labor for your clinician. Like we we shouldn't have to be in a system where that's the case, but this is reality. And unfortunately, if you want to get the best out of the interaction between you and a clinician,
00:17:29
Speaker
It does mean prepping a bit. It's also interesting, Julie, ah you mentioned that Shona's done a lot of work educating herself, doing a lot of use of medical language. It's a really tricky one.
00:17:40
Speaker
Using medical language more often than not fails rather than succeeds. Because it's highly contextual and highly specific. And the way we use medical terminology isn't just making sure that the words are accurate.
00:17:52
Speaker
The way we fit it into sentences has evolved due the culture of healthcare. And so if it's not used with the correct emphasis and values behind it, it actually stands out and says, this person's trying to use medical terms that they don't understand.
00:18:07
Speaker
And that actually backfires even more. I'd say probably like nine out of 10 times when someone who's not a health professional uses a technical term, it's in the wrong place.
00:18:17
Speaker
And it stands out like a sore thumb. Like someone says, my pain's really acute. My pain's really acute. It's a 10 out of 10. And to me, acute is a time span, not a severity.
00:18:29
Speaker
Acute's the opposite of chronic. Acute is less than three months and chronic is more than three months when it comes to pain. yeah And so like ah just an example, when someone says, oh, my pain's really acute today. I understand that what they're saying is their pain's really severe, but it also tells me that person is not au fait with the culture of healthcare.
Communication Strategies with Doctors
00:18:47
Speaker
care And instead of trying to, because essentially using technical terms, the reason we do it is to say, hey, I'm part of your team.
00:18:55
Speaker
What it does is it just shows, hey, I'm not part of your team. Let's get a reaction from Shona, because then I think we might move on to our next topic. But just your reflections on those comments. Totally understand where Aidan's coming from on this, because I've seen it myself so many times.
00:19:10
Speaker
And I think what a great strategy for dealing with that kind of issue is, because some of the time I want to pass on accurate information that is medical terminology from my other clinicians, which is true of many chronic complicated cases.
00:19:24
Speaker
I might say, here's what I've been told, medical language, and then say, here's what i think it means. And I think that's what we're both working towards. So when a a doctor recognizes that I'm using some of these terms from other doctors, if they can intervene and say, what do you think that means? Or what does that mean for you?
00:19:43
Speaker
That's really getting to the heart of what we're actually trying to communicate, which I totally get is what Aidan's getting at there.
Exploring PCOS
00:19:50
Speaker
ah So fascinating and we'll come back to Shona with ah another topic but I want to welcome now Alice, our philosophy student with an interest in health and health journalism and you wanted to raise the topic of polycystic ovarian syndrome.
00:20:05
Speaker
but In a moment Aidan will give us ah information about it but why have you raised this topic? What's your level of interest in this? I'm primarily interested in all things women's health.
00:20:16
Speaker
um It is a historically understudied area of health, which is wild to say, seeing as it's half the population. And that is improving now, especially a lot more government funding has come in with the new budget and these sorts of things.
00:20:33
Speaker
There is a lot more awareness now, but still it's things like PCOS, polycystic ovarian syndrome are largely misunderstood as far as I know. I mean, Aiden will give us a better explanation, but um there are a lot of theories and because of this, it seems a lot of women, which is as much as 13% of women have PCOS and yet There's no real cure.
00:21:02
Speaker
There are treatments but and ways to mitigate symptoms, but there's no real cure. And we still don't exactly know why it happens or like the best ways to treat it.
00:21:13
Speaker
And there's also a lot of hypotheses that it's a lifestyle disease. And with it being so prevalent now, I'm curious as to whether there's something happening in our current climate that's making it more prevalent or whether maybe it's always been this way and it's been underdiagnosed or yes it's just a very common thing in women's health that isn't spoken enough about and can create a lot of distress and needs to be studied more yes let's hear more about it then we'll come back to you again and help us with polycystic ovarian syndrome what what do we need to know
00:21:51
Speaker
So polycystic ovarian syndrome, it's common. It affects roughly 10% of women. Essentially, it's a hormonal issue. So it's the overproduction of androgens, which are typically considered male hormones.
00:22:04
Speaker
it It's a bit of a misnomer. You don't have to have multiple cysts on your ovaries to have polycystic ovarian syndrome, although that is the most common feature, and that's how we started diagnosing it.
00:22:15
Speaker
When we talk about cysts, people think that's a bad thing. What a cyst means is essentially it's a bubble with fluid in it. That's all a cyst is. And so when we talk about ovaries, and I just want to preface this entire conversation saying I'm not a general practitioner, I'm not a women's health expert.
00:22:31
Speaker
So please forgive me if I'm not 100% on this. I'm doing my best here. But when we talk about cysts and ooocysts, what we're essentially talking about are the little bubbles that form in the ovary are in anticipation of ovulation. And what they do is they are a normal process. Normally you have one cyst at a time.
00:22:52
Speaker
After it matures, it grows and grows and grows. And that produces the right hormonal levels for implantation of an egg. So you're supposed to have these little cysts, but you're not supposed to have lots of them all growing big at the same time. And that's where the issue happens, where you get two high levels of androgens, which causes extra de depositions of fat on the body. It causes excess facial hair.
00:23:14
Speaker
It causes some typically male associated features, and it causes things like pre-diabetes. It causes a combination of excess fat and poor sort of hormonal regulation leads to metabolic syndromes like diabetes.
00:23:28
Speaker
And it can, for some, as as I understand it, make it harder to get pregnant. Absolutely. I just coming back to you, if I may, Alice, I think you feel that there's some stigma and invisibility in relation to this condition and it needs to be raised and talked about more, which is why it's such a great thing to raise on our program.
Stigma and PCOS
00:23:48
Speaker
But it just strikes me that even hearing about the idea of excess male hormones is something that for many women that would be an embarrassment even to discuss with their friends perhaps. But your thoughts on stigma and the emotional aspect of such a diagnosis?
00:24:04
Speaker
I mean, I'm not speaking from experience, but I have a fair few people in my life who I've spoken to who are experiencing it. And that's absolutely part of it. I think more of the stigma might come from the fact that um the way it presents can be a hit to your confidence.
00:24:22
Speaker
Acne, ah hair in places that women wouldn't typically want hair, these sorts of things can be really difficult to deal with. Absolutely, I think there is a bit of a stigma there, but more so I think that the stigma probably comes in doctor's offices, as we were saying before.
00:24:40
Speaker
And this is not to generalise, but I think that a lot of the issue here is that women historically have come into doctor's offices with things like irregular periods and said something's not right or other symptoms.
00:24:59
Speaker
weight gain, things like this. And they're told eat less, move more, or put on the birth control pill, or these so sorts of things, which for some women may work, but a lot of the time it is an oversight. And it's because women are told that what they're experiencing is normal.
00:25:17
Speaker
This is the same for things like period pain, which periods shouldn't really be painful, but it's a reason that things like endometriosis were historically so overlooked. And it just comes from that's part of being a woman, quote unquote.
00:25:32
Speaker
So I think that the stigma is breaking as women come to realize that they should not be having to deal with these things, that this isn't normal and that they're not the only ones, which is the important part.
00:25:46
Speaker
of raising awareness of speaking about these things just so women know that they're not the only people dealing with this. Yes, ah it may be that we come back to this topic again, Aidan. It's obviously something of significance, but sorry, Alice, I interrupted you. No, that's all right. That's all right. I could go on about this forever.
00:26:03
Speaker
No, you know, what strikes me, Aidan, as I listen to these young women is just how important kindness is in the building of that trusting community communicative relationship and and also ah a theme that is common for people with, enormously common for people with cancer, but also other conditions is getting the diagnosis.
Healthcare System Challenges
00:26:26
Speaker
It's really interesting hearing you because I can see that you rightly anticipate and expect respect from your patient and yet for some of us because I obviously had the same thing getting in my head and neck cancer diagnosis is enormously common to be delayed we've had to go to so many doctors who didn't identify our problem before we get the diagnosis that we can express frustration and fear and Our social skills vary in terms of our capacity to hide it and stay respectful.
00:26:59
Speaker
It's a dynamic dance, isn't it, the patient-doctor relationship? Again, more reflections. Totally. And one has to acknowledge that medicine has a dark history of paternalism.
00:27:11
Speaker
it It was a male-dominated field that viewed the female body as nothing more than something to be experimented on. that You look at the history of things like hysteria, where all these things were seen as a fictitious imagination of a boardwoman, housewoman's mind, and it was a wandering uterus and she was mad and one should do cocaine to fix it.
00:27:30
Speaker
That was the history of medicine. You look at the history of obstetrics and gynecology and things were barbaric. But at the same time, we have come so far.
00:27:40
Speaker
There's no question that there is still many clinicians out there, not just doctors, everyone within healthcare who needs to improve how we listen to patients.
00:27:52
Speaker
At the same time, there are so many of us who are trying so hard to be the counterpoint to that. I think what's difficult is there's a pattern emerging, which is what patients want is not the way that our health system has been designed to provide things. Me as a patient, I want to go to a clinician and get a diagnosis because that is in and of itself beneficial to how I see myself and how I deal with illness and disease.
00:28:21
Speaker
The way the health system is currently designed is to promote the most amount of functioning in the most amount of people in the most efficient way possible. And what that means is for the vast majority of people, a constellation of symptoms is best treated with this intervention, i.e.
00:28:42
Speaker
an oral contraceptive pill or another medication in order to help that person function. Our health system is not designed for you to come in and get as many tests as possible to label a disease unless that disease is likely to have significant morbidity mortality.
00:29:00
Speaker
So actually it's a triage process and Your frustration with the clinician is probably shared by the clinician in many ways. What we find is a lot of people who do have symptoms come to their doctor and are able to function really well after the certain sort of basic treatment. And it's hard, I think, because there's probably a silent majority of women who do achieve a significant benefit from things like the oral contraceptive pill. And I feel like that's become maligned in a lot of the discourse when we're trying to empower women who are not being heard properly, both within their own communities and within doctors rooms,
00:29:44
Speaker
We often run the risk of maligning things, which are actually really beneficial, safe therapies for the vast majority of people and allow them to function. And so it's a difficult balance, but I completely hear Alice and I want other people to hear her as well, that we need to do better to listen.
00:30:02
Speaker
What I'm going to do, if I may, is come to Shannon Beresford, who's ah a death doula, and we'll hear about that in a moment, your work supporting people in end-of-life planning.
Burnout in Healthcare
00:30:12
Speaker
But I actually thought I might come to the second topic you were wanting to talk about first, which is burnout, the notion of the challenge of burnout for clinicians of all kinds, including doctors in the health system, but also the notion of burnout among people with chronic illness,
00:30:28
Speaker
or carers of people. Aidan is a junior doctor, essentially, and there's an enormous amount of stress on junior doctors. You bear an enormous burden of suicidality. That is a major issue. And it's clearly you're on the front line with an enormous pressure of time.
00:30:49
Speaker
Because but here we have this I speak too as a patient, I want trust, I want communication, I want you to see me, not just my condition. All of this takes time, whereas you've been trained to deliver, as you said, in a very timely fashion, essential care and those people in the waiting room. Shannon, tell us, why did you want to raise this question of burnout as a topic?
00:31:13
Speaker
I think it's just really important to acknowledge that burnout exists across everything. So not only the clinical side, the clinicians, and, you know, in my role, I see that I volunteer at a hospice each week and I can see the stress and the emotion running through the clinical team.
00:31:31
Speaker
But also, i guess, on the caring side, on the person who is ill or dying and their support, their carers. And ah don't know that we do such a great job addressing the burnout in that sphere. And i know clinicians are sort of focused on potentially pain management and keeping people comfortable. And I'm talking about end of life here, but I think we need to do more to address that burnout and the overwhelming stress that carers, particularly as they watch their loved one deteriorate,
00:32:04
Speaker
I just wanted to bring that up as a topic and sort of any thoughts that Aidan might have from a clinical side observing patients and their families. And will I just get you, if you could just explain what your role as a death doula is and how you work separately but in partnership with people like palliative care teams.
00:32:24
Speaker
Sure. So people may have heard of a birth doula who help at the beginning of life. They'll help midwives and all of the medical teams there. We help at the other end. And doula actually is an ancient job philosophy. comes from the ancient Greek meaning to be of service in a modern-day context.
00:32:43
Speaker
So our role is to basically travel with the person who is dying and those supporting them. so that could be family, could be friends, it could be community. And we act in a way that provides continuity of care.
00:32:56
Speaker
Traditionally from a diagnosis, we'll sit and spend time planning end of life plan with the person, helping get their advanced care directive in order. and then sit and almost companion that family i put a caveat in here that we are non-medical so we do as you said julie partner with the clinicians and other interdisciplinary teams i can never say that word correctly but we are there really to handhold guide support we can also help do some basic education particularly around the active dying space very much complementary
00:33:29
Speaker
from a palliative care clinical side and also from an end-of-life doula side, we all want the same outcome. We want to help that person have the best possible end-of-life experience. um That notion of the needs of the carers, and if I could just say for my cancer treatment, a stage 4 diagnosis was significant impact on my life for about 18 months, it was totally outpatient.
00:33:54
Speaker
I constantly went to hospitals, but I was a total outpatient. So that's ah if I could just ask you, Shona, ah have you had a mix of inpatient and outpatient care?
Role of Death Doulas
00:34:05
Speaker
Absolutely. I've had a range and I've done a lot of rehab programs and things like that. So, yeah, I'm really interested to hear across that sort of broader spectrum from that clinician side. And I love the sound of this doula side because you can have all types of care.
00:34:21
Speaker
Your thoughts, Aidan, on the issues that have been raised here? First off is putting a name to the face of burnout. It's when someone is exposed to excessive stress over a long period of time and it ends up resulting in a state of fatigue or exhaustion that's both physical and emotional.
00:34:41
Speaker
It's totally a thing. And it's totally a thing in people with chronic illness and their caregivers. And I think that's so important to recognise. because it's hard and it's exhausting.
00:34:54
Speaker
And it's interesting when I sit back and philosophically wax lyrical with my friends, we often reflect on the fact that our society has really done itself a disservice by moving away from small insular communities who support each other.
00:35:11
Speaker
In the traditional multi-generational household, one could rely on a much wider and deeper community of support to help any individual through a process. And we've lost something as we've evolved in Western civilization to have a much more individualistic lifestyle. We've lost the support of multiple individuals.
00:35:37
Speaker
And we know that people who have bigger, richer social support networks do better in most things. And we know that isolation is a significant risk factor and probably a causative factor in doing worse when it comes to most diseases.
00:35:52
Speaker
And so to have someone, anyone in your corner is of benefit. I think when death doulas first came out, medicine found the whole idea very challenging and very threatening.
00:36:05
Speaker
And nowadays, I think we are incredibly grateful that there is an additional person in that patient's corner and in that family's corner who's able to help them navigate the process because the health system's under strain.
00:36:17
Speaker
As you correctly identified, Julie, we are under time pressure, not by our own choice. If we can work collaboratively, I'm so grateful that there's people like Shannon who are giving their time and energy to people who are often relegated to the last priority in society.
00:36:34
Speaker
We spend a lot of time and effort after someone's died. funerals, memorials. In the process of dying, it's a very yucky, icky, uncomfortable space that a lot of people feel very discomforted sitting with. Very few people feel comfortable to sit in the rubble with someone. And I wanna quote that, sitting sitting in the rubble with someone is something from Dr. Liz Crow, a phenomenal friend of mine who's written her PhD and does her post-doctoral research on burnout in healthcare professionals and was the senior social worker at Lady Cilento's Kids' Hospital in Queensland.
00:37:08
Speaker
It's sitting with someone who's dying and just being there with them is very uncomfortable for a lot of people because we've sterilized death in today's society. We don't, confronted A kid growing up on a farm sees animals dying.
00:37:21
Speaker
A kid growing up in the city doesn't have a relationship with death except for the sterilized death of a grandparent. And so it's so useful that there are people in our society who are becoming experts in sitting with someone as a non-medical professional with less of a power dynamic holding their hand through that process.
00:37:38
Speaker
And when it comes to burnout, solutions-wise, It's hard. There are social workers out there who are able to help. There are programs out there which are able to give some assistance, but the reality is a lot of people feel like they're on their own. And that's true because there are few, and they when I say few, there are programs and supports out there, but there's not enough.
00:38:00
Speaker
And when you're living with being the primary support person for a person with chronic disease, an illness every single day, it's hard. You don't sleep properly. You're worrying about them at night. And a break for three days a year probably isn't enough.
00:38:15
Speaker
And that's the person supporting the person with chronic illness, let alone the person with chronic illness who has to get up every single day and and not just do everything else that everyone else has to do, but has to spend hours taking care of themselves. It's bloody hard.
Community and Support Networks
00:38:29
Speaker
Can I come to you, Shono? What are you thinking about with this? ah get You are faced with a life-limiting illness and an enormous ambiguity. You seemed quite interested in in Shannon. is there Are there questions you'd like to ask Shannon or Aiden or aan ah comments to make? Actually, I was also thinking about Alice in this because I was thinking about the person with PCOS and other issues and actually the burnout you get from self-advocacy.
00:38:55
Speaker
can be huge because you're not just the person waking up with those experiences day to day, living with the symptoms. you're also trying to do that caregiver sort of for yourself, thinking ahead, managing all of your different appointments, all of your different clinicians. There's a kind of burnout there as well.
00:39:12
Speaker
And as Shannon was speaking, I was thinking about death doulas as just another kind of community and another type of connection. And what Aidan's saying about find your support networks.
00:39:23
Speaker
I think what I'm hearing here is like finding your people, which really resonates with me. I found my cancer community. I found my disability community. And I think even hearing Alice speak, there are women's health issues. found community there as well.
00:39:39
Speaker
So spread the load is what I'm hearing from the burnout side, but it sounds like it applies equally to end of life issues. And Shedden, your experience of people coming to you with anxiety and concerns and what you observe over the time that you're working with them, because you you going go right through to funerals and everything, don't you? It's the whole life, end of life.
00:40:05
Speaker
Absolutely. We do cover the whole spectrum, including after death. So actually helping to support the family or the person or people right through to their memorial, their funeral, and even a little bit beyond. There are some grief experts that sit within the end of life doula space.
00:40:21
Speaker
And I think Shona, what you were saying about community really is true. And it's, there's multiple layers, almost like a ring of different communities. So you have your inner sanctum where you have the person, those immediate carers, perhaps we as doulas might step in there to provide some of their gardens at the end. And then you go out further into different aspects of community, but they all chip in to help support. And as death and end of life is changing here in Australia, and we are seeing changes, some fantastic changes,
00:40:51
Speaker
hopefully that community aspect of dying will increase and really bring it back to where it used to be pre-World War one That's when death and dying globally really changed because of the sheer volume of people dying.
00:41:07
Speaker
And one of the things that I enjoy with Aidan is that he's totally relaxed about talking about death, which puts you into a and a relatively small group of people. And and sometimes Shona and I have known each other purely through having cancer diagnoses, that we can relax and talk about, if you can talk about death or something with me, and I'm not going to panic because I've, you just get, I'm sorry.
00:41:30
Speaker
I don't want to say used to it, but you if you live in the cancer community, you know people before they die and after they die, don't you? It's somehow part of our lives more. Yeah, you it's that instant sort of you bypass the social awkwardness to this kind of intimacy.
00:41:47
Speaker
So it's just you just get it. And that's true of all the communities I've mentioned so far. And I think it sounds true of the sort of death and dying and doula community that what you're describing is that kind of interdependence, which is so true of disability communities and we celebrate that.
00:42:02
Speaker
There's nothing wrong with needing other people. It's wonderful to need other people and it's a fact of life. So I think that sort of intimacy recognises we're going to need each other and that's good. Aidan, ah just before I come to Alice's next topic, i just want to say, because I have brothers who are doctors, my stepdaughter's a doctor, think it's very hard for doctors to deal with disability feelings of distress and even thoughts of hurting themselves or suicide because but I remember the moment that my daughter became just a medical student people already began to give her a certain level of extra respect and to start asking her questions literally you you are it's almost forced upon you this mantle of authority even before you're ready for it and also I think
00:42:53
Speaker
and I have a law background, so I think it can apply in the law to the young lawyers as well. There is a, I still think there's a taboo about expressing psychological vulnerability. You've got to look strong out there. Am I wrong? But your comments on those thoughts?
00:43:09
Speaker
No, I think you've hit the nail on the head. There's a taboo and we're doing a huge amount of work now to normalize the fact that within medicine, a huge amount of work to normalize the fact that we are human and we have the exact same issues as all of our patients.
00:43:22
Speaker
And we are even more vulnerable to mental ill health than most of our patients just by virtue of the trauma we're exposed to occupationally and the stress that comes with that.
00:43:33
Speaker
Yeah, I don't think I have more to say rather than there's a taboo that we're doing our best to create an alternative narrative to that. And we're trying and sometimes we're failing, but we're trying. And Shona, if I could just ask you one last question. Cancer Voices South Australia that we're both meant members of, it's ah I'll get ah Shona to explain it, but if you could just talk about the survivors as teachers program at the University of Adelaide and how those gatherings of medical students, quite often some of the students start crying.
00:44:03
Speaker
Just briefly to give a sense of how we create a space where medical students can show vulnerability. Yeah, sure. So Cancer Voices, South Australia, we're an entirely voluntary organization patients, by patients.
00:44:18
Speaker
We run tutorials for the medical students at the University of Adelaide. We run 12 or 15 a year, think. about twelve or fifteen a year i think that every third year medical student has a session with us and we bring a cancer patient or carer or widow to those classes and full two hours, that person gets to tell their story, the whole of life story, the things that they think are important.
00:44:43
Speaker
And what's really great is that the medical students get the chance to ask questions in a non-clinical setting. This is not a medical placement. They get to just see us as people and we see them as people. And it's really emotionally moving. As you said, we have all kinds of conversations that pop up just depending on what those students are interested in and what the speaker wants to share about their story.
00:45:04
Speaker
So I think that's one way we're trying to build that sort of empathy, interested, storytelling, interested sort of tool into the medical school to try and maybe tackle some of that taboo around dealing with difficult things on both sides.
00:45:21
Speaker
And they are so keen to ask patients questions without being required aid and to do those very precise questions to get a particular diagnosis. It's more like a conversation.
00:45:33
Speaker
I wonder if the tiers too, i did a number of them during the COVID campaign and again a lot of these were international students separated from their families. So they were very vulnerable. But let's move on to another
Men's Mental Health Issues
00:45:44
Speaker
topic. And Alice, it is a serious topic, but one of immense significance, and that is the issue of suicide, particularly among men and young men.
00:45:53
Speaker
Why did you want to raise this one, Alice? Really, this is just a shocking statistic that i learned very fortunately very recently, which is that the leading cause of death for Australian men under the age of 50 is suicide.
00:46:07
Speaker
And not only that, but it is three or four times more likely that a man in Australia will die by suicide than a woman. And this, there are, I'm sure a lot of reasons for this, but I also looked deeper and I thought, okay, maybe this is a recent trend, maybe since COVID or some large scale global event that would have really affected men's mental health.
00:46:30
Speaker
No, this is, there was no change. It just is a very constant and scary statistic. And I think that this plays very well into the conversation we were just having about the taboo around emotional vulnerability, expression being seen as weak, or even as Julie, you were saying before, maybe a bit crazy for expressing your fears.
00:46:55
Speaker
And I think that this is just such a big problem that needs to be discussed. And out of interest, is it something you've ever talked to with your fellow uni students, your male friends at uni?
00:47:07
Speaker
They are actually the ones who inform me of it. I think men are very aware of this statistic as far as I know. And women don't seem to be, which is very interesting.
00:47:18
Speaker
And it also seems to come up frequently around the times of things like Are You Okay Day or Movember, um these kinds of things, which are fairly problematic, actually, because they take something so serious and sort of lighten it in a way that maybe isn't actually helpful.
00:47:40
Speaker
So I just would like us to all think about maybe something that could tangibly be done to improve this statistic. Thank you Aidan, I'd love your thoughts on what can tangibly be done. I might come to you Aishan and Josh our producer is here if he wants to become a voice on our program but let's start with you Aidan Aishan. want to thank you for bringing it up.
00:48:04
Speaker
There's a huge amount of work that has looked at men's suicide and particularly young men's suicide over the past 50 years, sort of five decades.
00:48:16
Speaker
And I particularly want to make mention of Associate Professor Zach Seidler, who's the psychology director who's now been appointed to Movember, but has done some huge work lobbying for increased government funding in this space and has done some great work on effective interventions.
00:48:32
Speaker
The sort of intervention, and I use intervention as a medical terminology to mean a thing that we do to a group. The intervention that we've been pushing for the past sort of 15 to 20 years has been ineffective.
00:48:45
Speaker
And that's been to tell men that they need to get in touch with their feelings. and that doesn't work and because it relies on presenting a gender binary of men are clammed up and women are emotionally intelligent and men are strong and women are weak and obviously this is a patently false dynamic but it plays into social expectations and pushing that means that the underlying assumption is that you must be less manly because your manliness is bad and you must be more feminine. Now I'm dealing with absurdly reduced models here, but essentially what we've been pushing the past few years has not been working.
00:49:27
Speaker
There is research from Professor Seidler's work, which is very nuanced and has, I think, probably the biggest potential to shift things. ah But I do want to push back on the issues around Movember and RUOK Day. I used to be very skeptical about RUOK Day. I thought it'd become a corporate gimmick.
00:49:45
Speaker
And in some ways it has. But at the same time, It has increased the discussion about suicidality and it has allowed it to become more normalized in conversation. It has increased our fluency with those words.
00:50:03
Speaker
And it probably has had benefit and the literature is difficult to interpret, but the fact of the matter is it probably has had a benefit. And I actually do support those campaigns in the same way that I did not think the ice bucket challenge for, do you remember when we used to pour like a bucket of water over people?
00:50:18
Speaker
I thought that was rubbish, but it ended up raising millions of dollars. for amyotrophic lateral sclerosis, ALS. It ended up having a massive impact on ALS research.
00:50:31
Speaker
And thanks to that, actually a whole raft of new therapies are hitting the market now and are able to be used by patients. So I actually, as much as I find IU or K-Day personally cringy for myself,
00:50:45
Speaker
I really like the impact it's had on society and that it's increased our fluency. And coming back to men's mental health, I'm so appreciative of Alice for raising this point. And she's 100% right. This is an issue that is not new. It's been going on for decades, if not millennia.
00:51:01
Speaker
And there's all sorts of reasons why it's the case. Things like... When people attempt suicide, men tend to use more lethal means and women tend to use less lethal means.
00:51:14
Speaker
And that has to do with a whole bunch of social reasons. Things like men tend to be isolationist and tend to be isolated socially because of the way our current society works.
00:51:26
Speaker
We could sit here for days discussing all the factors that go into it. But there are solutions and there are programs and they're coming. And could I just ask you just a little bit more about that? Because my understanding is there can be a common association with depression and the dealing with depression. But could you just give us an indication of where the hope lies, either currently or foreshadowing?
00:51:52
Speaker
I think, and I want to be very clear here, that I'm not an expert in this area. And it's a very specialised area. Most people are not an expert in this area. um My rudimentary understanding is that it's a combination of things.
00:52:08
Speaker
One is community. Two is creating a narrative that young men are able to relate to, which is empowering as well as allows them the language to talk about their vulnerabilities without disempowering them or emasculating them.
00:52:27
Speaker
And I, my understanding is that is where things are. And then ultimately it is increasing the ability of that population to access healthcare. care And we know that young men, the most difficult to reach population when it comes to any healthcare intervention, I'm talking sunscreen, I'm talking al alcohol and smoking reduction, I'm talking drugs, I'm talking cancer screening, you name it.
00:52:50
Speaker
The most difficult thing to do is to get a young guy into a GP office. Can I jump in here for briefly? So quite a lot of my disability advocacy happens in the university space in building social clubs and things at university.
00:53:04
Speaker
And I've found that quite a lot of young men come to the disability social club and that's the first time that they're really getting a sense of community. They're bonding over the identity of disabled and the various shared struggles we have in the disability community. And I think the same is true in cancer spaces. I've seen wonderful men's groups.
00:53:27
Speaker
specifically around cancers that are associated with men. And it's usually those but perhaps later in life that those men end up with a group of people with shared experiences, shared struggles who have bonded because something else has come up.
00:53:43
Speaker
So I'm wondering if it might be the same with end of life care as well, that it's only once there's another issue and another entry point that men can come into a community where we deal with these things like the various struggles and we get have that intimacy of community, there's got to be a way where we can better provide mental health care in those contexts, but also not have to have people come in through that side door, if that makes sense.
00:54:09
Speaker
Could I just check one fact, Aidan, and then I want to talk to Shannon, if I may, but my understanding is that the there is a very high level of big increase in suicide attempts and successful suicide among men in later life, but in old age as well.
00:54:25
Speaker
So it's both young and old age. but but You're nodding. so Absolutely. There's ah what we call a bimodal distribution. There are two peaks. There's the sort of early life, the between sort of 16 to 30-ish and you the rough age group.
00:54:39
Speaker
And then there's the later in life, sort of 65, 70, 84, that particularly after retirement, later on in life, there is a massive uptick in suicidality and for both genders.
00:54:52
Speaker
ah Exactly. So just coming to you, Shannon, yeah but if you wish to talk about men or women, and I suppose you're by definition dealing with a group of people who've had a scary diagnosis of some kind, I'm assuming.
00:55:06
Speaker
And your observations around... ah psychological well-being and again I know that the opportunity to have a sister dying is separate from suicide and there's quite strong controls about that but yes I'm interested in do you observe assist people to manage their spiritual and psychological pain if they're facing a an end-of-life diagnosis So there's two comments I'd like to
Supporting Families After Suicide
00:55:36
Speaker
make. The first is that as an end of life doula, we sometimes don't just travel with a person through an illness journey to end of life.
00:55:45
Speaker
We can get called into families where they have had a suicide in that family. And then we come in to then help support the family following that suicide process right through.
00:55:57
Speaker
So that is a very important part of our role that may not be so obvious, but we can certainly come in and support a family in that instance. One interesting observation I do find through sort of contact with clients and even my volunteer work at the hospice man Men are not good at talking, at sharing feelings, emotions.
00:56:20
Speaker
And, you know, I'm not a clinician. have no idea. I'm guessing stigma, a whole bunch of things that Aidan's already talked about. But it is very evident at the end of life, if I can spend time with a bloke who has multiple cancers and has not long to go sometimes I have the gift of spending time and breaking through some of those little pieces. And that really is simply sitting and listening.
00:56:47
Speaker
There are a bunch of clinical supports and all sorts of other wonderful mechanisms within that space, but sometimes the pure human element of just sitting, listening, holding a hand,
00:57:00
Speaker
can make a massive impact. I have to, if I may make a quick comment myself, I participate in a faith community, a unit uniting church community, and i i sometimes do wonder about the, yes as I understand it, there's a significant drop in participation in faith communities. While there are parts of the Australian community that have very strong cultural and faith relationships, but one of the strengths of being in a faith group is that you mix with people across generations and so you within one day with one service you can hear about death, illness, birth, birthday celebration like it's some it's all tumbled up together and plus most faith groups
00:57:42
Speaker
have ceremonies ah associated with all the different stages of life including loss and celebration and i sometimes feel fortunate that I am part of that kind of community and ah it certainly when I had a throat cancer which due to radiation treatment I lost speech completely for six months and it wasn't really very good for about 18 months and I can still remember just being able to turn up at my church stood up the back with a blanket around me and when I had no voice.
00:58:09
Speaker
And nothing was expected of me because i it was a familiar group. Now, I'm not saying it has to come from faith. It can be a sporting club, the sort of university club that um both the students here have referred to.
00:58:24
Speaker
But we've definitely lost some level ah of that... um structural community. but guess you you see people celebrating either the loss or the success of their political party. They're having this conversation just after ah an Australian federal election.
00:58:41
Speaker
That is a kind of bonding, isn't it, where everyone's in the same colour t-shirt and grabbing, either a laughing or crying. Josh, did you want to say something? Actually, I did. i don't usually talk during our podcast. I'm often very silent. But just on the topic that we mentioned, on the discussion of public discussion about men's health and men's suicide, I feel like, and um I'm, again, not a clinician and not an expert. I'm a lawyer of Julie's Mold more so than a doctor of aidants. But I feel like when we talk about the growth in men's suicidality, we talk a lot about
00:59:20
Speaker
what men perhaps might be missing from society as we understand it today. And hearing what Shannon had to say about men not necessarily being good at expressing how they feel.
00:59:32
Speaker
I often feel like when I'm talking to men they're very good at expressing what they dislike or what they or their opinions or what they think and perhaps not. it And you can actually read the tea leaves on what they're feeling because they're telling you what they're thinking.
00:59:48
Speaker
And you can see how certain things make men feel. i know I'm talking about men like we need to be decoded. But the point I would make is we think about... what men don't have or what men might be struggling with.
01:00:02
Speaker
And part of that, I feel, that it misses the mark on what suicidality and what suicidal ideation is, because it's not necessarily ah recipe of put more financial stability in get more good mental health or it's put more perhaps community engagement or faith or involvement in and get better mental health we are talking about when we think about mental health we often think about like how should people be thinking and there are so many biological determinants of mental health and
01:00:34
Speaker
There's an episode that will come out soon to talk about the potential for S-ketamine to be useful in treatment-resistant depression. And it just makes me think we think a lot about mental health as a deficiency in people's thinking and perhaps in relation to the society around them.
01:00:50
Speaker
And it's a lot more about biology than we acknowledge. And sometimes that's difficult to grapple with because we don't necessarily know what to do about it. Anyway, that's all just a bunch of thoughts that came up in the listening to the discussion.
01:01:02
Speaker
I'm just... like to say on behalf of Dr Aidan Barron and myself as co-hosts how delightful it is to hear our producer talking to us I don't think we need another topic I think we've had such profound reflections what I'd like to do if I may is ask Shannon to hit his special bowl he's got a bowl that makes a beautiful sound that he uses at the hospice and elsewhere I might hear that bowl and then wrap up our conversation okay
01:01:38
Speaker
I have to say I was once very sick in hospital and someone came in with one of those bowls and it was oddly therapeutic. But I think, Aidan, I want to thank Alice and Shannon and Shona and our producer, Josh, for a really thoughtful ah range of reflections on really interesting health topics. And Aidan, let me hand over to you to close our program. Thank you.
01:02:04
Speaker
I'm really grateful for all of you coming on today and being vulnerable and sharing with us. And I just want to thank you for that. And for all the people listening, thank you so much for sharing those stories to help those of our listeners. I guess my final thought for today is how important communities are and reflecting one of my favorite controversial thinkers, Ivan Illich, the way that communities produce health.
01:02:28
Speaker
and how that really sustains us. And thank you again, for those of you listening, make sure to like, subscribe and follow for more. Hope you have a great week. This is This Might Sting, where we diagnose nonsense and prescribe the truth.
01:02:40
Speaker
Take your medicine as prescribed.
01:02:44
Speaker
This Might Sting is hosted by Aidan Barron and Julie McCrossin. Executive produced by Joshua Kirsch. While we always work to give you the best information and tips, nothing in This Might Sting should be construed as personal healthcare care advice.
01:02:59
Speaker
You should always make health decisions in consultation with your general practitioner and specialists. If you'd like to hear us talk about a topic on the show, or if you think we've made a mistake and want to request a correction, please contact us at questions at thismightsting.com.au.