Myth, Magic, Medicine, and everything in between -two doctors talking. Hello, and welcome again to Myth, Magic, Medicine with me, Denise Billen-Mejia. And today I have my friend all the way from Dublin, Dr. Fiona Mackin, who's joining us to talk to us about, well, what she does in medicine. Hi, Fiona, thank you so much for joining us.
Thank you very much for inviting me. It's lovely to be here.
Right before we did the intro there, I was asking you about your original training and how from my days in the United Kingdom, a little bit different from Southern Ireland, but not terribly. It was it was still unusual for a woman to go to medical school. This is 20 years before your time, by the time you were going to school, it was more accepted, you think?
Yeah, definitely, our class was 50/50. So in that class, at Trinity we we graduated in 1997. So you're talking about from 1991, to 1997, and our class of 70 people there were, you know, 35 women 35. That's very small class, but very much half and half.
But now the division for specialty training, you'll probably have to expect most people that listen to this are American, not everybody, we got a few people around the world. But the system is different here. Specialty training you, you everybody does 2 Foundation Years?
So when you finish your training, as in 1997, you weren't qualified as a doctor, you spent a year then as what we call an intern. So I even think in the UK, that was a different name that was a
house officer, I think it's I think that the difference between that and some of the Europeans, some of the European systems and a few others, I've interviewed some people from other countries, they incorporate the internship into medical school so that when you come out, you have the ability to be licensed than to put your shingle up and start seeing people and for general practice. That's not the case in in Ireland, you come out, and you have to take a year before you can get licensed to work independently.
Yes.And that year, you're allowed to prescribe medications, but only in a hospital setting and under the supervision of senior doctors,
right, that's basically the same thing here, you have to be in some sort of a residency program, which is our specialty training. Sometimes you can be there's a more general rotating internship for a few those are usually done by people that are going to go into I think, psychiatry ophthalmology to you've got to be tracked to go in those, but you'll need to have some general medicine practice first. Now, when did you just start? Because you're a general practitioner, right? Yes. Just roughly equivalent family practice here isn't quite the same. But what, what, what drew you to that it? Was it what you really wanted to do right up front? Did you think you might want something else and changed your mind when you saw what it was really like,
Yes, so I was convinced the whole way through my training that I would want to do psychiatry. And I I met psychiatry as a junior doctor, they came in and they helped me whenever I'd have difficulty when I did medicine for the elderly, the if someone was in trouble, the psychiatry people came in. And it wasn't what I thought it was they came and they fiddled about with drugs and they change drugs, but I thought that they'd be sort of taking a look at the whole person and, you know, this person's life and, and it seemed to be even more medication base.
Right.I think that's a complaint worldwide. But do you think that is a failure of the system? Or is it the, are people trained not to see the whole person if we had if we hadn't, apologize for not knowing enough about Southern Ireland, the National Health System, you have a very similar system? If you are if you're in the National Health System, and it's strapped for money, those nice things are likely to be the first things that go if they weren't strapped for money, and I think we can only pray for that. Do you think it would be better from the point of view of what they're trained to do?
I think so. And I think that's in to two regards. One is The amount of time that it takes to do the talk therapies and the the trauma work or any of the stuff that I actually have a huge interest in both time and money. So it's much easier to spend less time to see more patients, and then just write a prescription that that, for two reasons is sort of the way that that psychiatric medicine has gone to now. And medicine. I think even in general practice, I think what I see is probably a much bigger picture stuff.
Yeah, I think a lot of us complain that we spend most of our time putting out fires rather than preventing them from happening in the first place. Yes. Which segues nicely into, after you were in general practice? Where did you take your career? What did you decide you were going to do with it?
So I still work in general practice. But I have also gone and trained as a mindfulness, Mindfulness Based Stress Reduction teacher. And why? Why did I do that? So I have suffered from depression, my I've shared that with all of my patients, particularly any who have any mental health struggles themselves. So I did a course as a student, I had three children at the time, the youngest was a small baby. And during that eight weeks, I actually realized that I had spent most of my life in my head. And this was the first time that I realized that there was another place to be other than in my head. And when I found the relief that that gave me, I thought, I'd really like to be able to teach this to people, I'd like to be able to teach it. And I'd like to know more about it. Because I'd actually really like to help people in a way that this has helped me
is the system such that you can use that when you're in practice, or doesn't have to be something that's outside of you can refer people to yourself, essentially.
So mainly outside of the practice. But because of the work that I do, it's, I suppose I almost embody it. Now, do you know that you come to see me as a GP and your blood pressure might be a little bit up, and I actually get you to do a little bit of breathing while I do it again, or you're, you seem very upset when you come in, and we might do a little bit of breathing. So the patients know what to expect from me. And also, it's, it's part of who I am now, the mindfulness teacher is part of who I am, I suppose. Yeah.
Are you restricted in Ireland? The amount of time? Here in the US it's like, seven minute increments for a routine visit? I mean, not for annual, not for an annual visit. I mean, that's a much longer period of time. But still, you're restricted on how many points you can hit? I'm sorry, that's a new problem. Have you got a new appointment for that? That problem? So do you have similar? What's your average appointment?
So longer? So the system in Ireland is such Yes, we have free health care. And they have a medical card, but we also have private health care. Now we don't differentiate between the two timewise in the practice where I'm working, but 15 minutes is what I have for a routine appointment. So 15 minutes. Yeah, I can, I can do a little bit of breathing in the 15 minutes.
Watch out what kind of breath work you practice.
So what I'm mainly using at the minute would be related to the polyvagal theory. So the sort of seven in an 11, I start one where we're getting that out breath to be longer than the inbreath.
I trained in that probably 20 years ago not called that then it's called coherent breathing, they still have that program. So you start with five in hold for four breathe out for five, and then as you and then you gradually lengthen the breathing out, yeah. As you get better at it, and that was, well, we'll get into our personal medical histories maybe with a little bit. I also suffered from depression. I'm not sure too many people on the planet don't have some degree of depression, obviously. Colloquially, yes, but but actual clinical depression. I think many people do. Certainly in the UK in my generation, you didn't talk about it, they were likely to give you brewers yeast and tell you to buck up because those things unless you were seriously, seriously ill but you could be very, very unhappy for a very long period of time and clearly need help but not get it mostly because of that. that stigma and the veneer of Everything's just fine, thank you. So many people are depressed and just you can nobody can see this as an audio but I'm grinning, that's the way you behave. I don't whine stop it stiff upper lip. What I find interesting is it sounds like you're not as stigmatized in Ireland, as we are in the US, or is that just because you refuse to be stigmatized?
That's such an interesting question. I think I have decided to refuse to be stigmatized. But it's definitely still there. It's not as if, when I share that information with my colleagues, that they all share it back about their mental health. So it's there. No, there's definitely still stigma here. Definitely still stuck here. And there's concern, I think about admitting that you're depressed and what that might mean for your career.
Does it threaten your license in this country in the US, in some states, it can threaten your license?
So yeah, it you'd have to be your work would have to be affected, but it doesn't, otherwise not. Um, so I, yeah, I just, I just feel it's really important to have it as part of the conversation. So that the stigma goes because as I say, to people all the time, when they come in to me, if you had diabetes, we wouldn't be having this conversation, we we would be talking about your insulin, and what you needed. And we wouldn't be having this conversation about I wish I didn't have to go on medicine, or I wish that this was different, you might still wish it was different, but we wouldn't see. Personal, you know, it's,
a FAILING feeling still, that's the problem life in general, the effect,
the effect of not feeling safe. What the cause has on our mind and our bodies, is, you know, what, I feel that COVID in itself had done it. That COVID was a time where we didn't feel safe, the children didn't feel safe, the other adults didn't feel that nobody felt safe, because we had this enemy, we couldn't see the enemy. And you could die at any moment. So that that's left it's wounds that we might not be aware of the wounds that that has left for people. But I think the polyvagal theory of stress explains that very well. That's interesting, but I definitely see it in work, people don't feel right, is the kind of the way that people are describing how they're feeling at the moment. They don't feel right. There's something not quite right.
Well it still isn't over, there's a new variant or I mean, I think that there's a certain amount of fatigue with the whole thing. Okay with that, so 2020. But you're seeing more people wearing masks, again, in the supermarkets, because they're aware that there's another variant coming by and we don't know if we're going to be covered yet. So I just very, very stressful I'm thankful the little ones that were born in late 2019, early 2020, and didn't see another non family member for the first two years of their life. Just socializing children is a really important part of their lives.
Yeah. Yeah. And for the for them as adults, then what what scars does that leave when it you didn't feel safe, like you didn't see other humans and didn't have that normal interaction?
I actually see quite a lot of the I'm a hypnotist. I see people my age and sort of around who may have recently lost a partner for one reason or another. And because they had that isolation, you know, we get used to what you get used to you assume that's what safety means. So even when safety and your comfort zone is not very comfortable. You want to stay just there. You don't want to go out so I have older people who are sort of run out to the shop and run back home. They don't they don't want to socialize, they don't feel safe. They want you to intellectually, they want to hence they come to me, but they can't get over that. You know, it's it's a dangerous world out there. Yeah.
And how So hypnosis is probably one of the things I don't know a huge amount about, but it's very interesting. How, how does hypnosis where is that getting in to help with those feelings?
Yeah, when when you put somebody into trance and everybody can go into trance Now not everybody every time with every single hypnotist because you have to trust them. But when they're in trance on their conscious mind is taking a nap basically, it's there, it's not You're not asleep. But it allows the suggestions that are being made by a trusted voice to slip past that critical mind and become lodged in your subconscious. And it you add usually you work more on adding positive things than trying to subtract negative it's always easier to add a positive. It basically we believe that everything that's your unconscious bias, which would be the world is a dangerous place, or I hate broccoli, or you know people brown eyes are weird, whatever, whatever your unconscious biases are. Those slip in because somebody you trusted said a thing or respond in a particular way when you were experiencing whatever that is. And so that becomes part of your, your known that your default mechanism. And so hypnosis adds a new thought, or can help you change the way you respond to a thought. trigger response, you give people a new response to go with a trigger. Yeah, usually, it's I think somebody have had recently, somebody who's hates public speaking, or you know, has panic attack just thought of having that ring just making public very common, almost as frightening as death for most people. You that You see, when they start to get that feeling of a panic rising, you give them an anchor that is been linked to thoughts of safety, thoughts of comfort. So whilst they're under hypnosis, and they're off in lalaland , so it's like daydreaming, really, you're imagining a wonderful beach and the waves are beautiful, and the sun is shining on you associate a pinching your fingers together, you associate that feeling with that. And so when you do this, your brain says, oh, that's where I am. And it just takes it down a pack so that you can breathe. Breathing is very important, as we know.
So I did training in neuro linguistic programing well, so that we did the most
right most hypnotists have, it's sort of sandwiched in there with Hypnosis Training. It sort of grew out of, although some NLP people will yell at me if I say that, but it really grew out of a lot of Erickson's work, yes by the conversational hypnosis where you don't have formally go into a trance. But that bits that
words are incredibly powerful,
incredibly powerful. And even that piece, so I went to a conference in 2018, and it was in integrative medicine. It was in London, didn't have anything like that in Ireland at the time, although I think that's changing. And there was a doctor there who worked as a GP and he did hypnotherapy. And there was another guy there who did general practice and NLP, as I always remember, which is the reason then I kind of thought I'll do a bit of that him talking about, if you're giving an injection to somebody for their rheumatoid arthritis that you would tell them that it might hurt a little bit, but that actually in the majority of patients, they do really well from this injection, that the evidence, you're not telling them an untruth. But you're deciding which information to give them first and which to give them last, and how powerful that is.
And the only thing a hypnotist would say we never use the word pain, which isn't completely true, because if they've used the word pain, you have to honor how they experienced the event. But we've all had children here, you and I, yes, if you suggest to a woman that is going to be absolutely miserable, giving birth, and it's going to be so painful. You are not doing them any good service is also to say it's all going to be just wonderful. You're going to be skipping around having a great time. This is also not true. It may well be uncomfortable, but we can make it as comfortable as possible. And it's a wonderful thing that you're going to be doing and we're going to be helping you and there'll be somebody with you all the time and take a deep breath all of those things. Do you have the as much in the way of doula practice there, you have doulas.
It's increasing. So as the
midwifery is also stronger, I think in the UK, the more traditional midwife.
Yes, oh, very much. So we would have a program for home births that would be midwife led . And the midwives would be would be very strong here, very much. So I know the Rotunda hospital, which is one of the maternity hospitals would be quite famous for being the place where they kind of started to track labors, and dilation versus time and that sort of stuff. So but the midwives themselves would be very much that they they would be the bosses. You know, they're very, yeah, very strong.
But if you need an obstetrician, and you need a cesarean, they will allow you to see
absolutely, oh, yeah, no obstetrician is, is is there. And the obstetrician is the person who makes the final decision. Most definitely. But the midwives are working beavering away as well to know so yeah, there definitely seem to be a balance of power, and
like balancing that balance.And if people probably are familiar with Call the Midwife, that's yes, I was born during that era. I was born in 1954. So it was all new and exciting. But I grew up assuming that I could go to the doctor, if I needed to go to the doctor, and I didn't realize money entered into it at all. When I was a kid. It was quite a rude awakening to practice medicine here. I've been if you want to Call the Midwife, we just have a little segue started. You'll see GPs is being involved in birth. And here family practitioners, not all but most are certainly trained to do routine deliveries. Do you yourself do routine deliveries? No. Is that by choice? Or just it's separated out now?
Yeah, no, it's very much separated out. So even you're qualified.
I saw your alphabet soup. Oh, yeah.
And obstetrics? Yeah, the BAO is obstetrics. All right. Yes. So in Ireland, definitely. The GP did have a bigger role. But as the years have gone by, and I suppose probably because of the legal end of it, it was encouraged that we wouldn't take that role on. And rather than that we would take that role on so that I wouldn't know of any GP who is involved in
Are you involved in prenatal care? postnatal? Yes. Okay.
Yeah. So the antenatal visits, you have a choice of coming to see me or to see the doctor and the midwife in the hospital or a bit of both. So most people pick a bit of both. And then your two week check would be with us, and the six week check would be with us. So yeah, a bit of both. Yeah.
and well baby checks are with you, too. You take care of children, unless they have a particular problem that you then refer.
Yes, yeah. Yeah. So there would also be public health nurses who would do the developmental checks. So there would be developmental checks done during those first two years. And if they're concerned, they might speak to me, but I'd be sending them to a pediatrician.
Okay, just just a quick check, because terminology does tend to differ between country's public health nurses are those nurses who are trained in public health or nurses who are employed by the public health system.
So nurses employed by the public health system, okay.
So they don't have a master's in public health. It's a different Okay.
Okay. Yeah. But you these would be nurses that are involved in the community. They would look after developmental checks, there would also be dressings. They I would ask them for help if I felt that we needed to get a care package in to someone at home. They would be my first point of call because they know who is involved in the care packages are looking after people at home. So they have a really, really busy, important job and are overworked and I I would probably underpaid, as well as lots of people are But yeah, they they're they're so busy. But yeah, that they do a lot of that work. So bit of everything really they're seeing all ages to
what when they go into the home so they'll see everybody in the family that's, that's the integrative bit you need is no point in dealing with one person and their problem with the connected all these other people. Yeah, everything all the time, everywhere, whatever that movie's called. Okay, so let's go back, let's go back, you got interested in depression and mental health in general and destigmatizing it, you got interested in you realize that psychiatry wasn't going to enable you to affect people's health the way you wanted it to? So you chose to be a generalist? What aspects of mental health do you feel you can look after? For the patient? Obviously, if you find somebody who's schizophrenic, you're going to refer them? But what of what? What level of care? Are you comfortable with at the GP level?
So that's a really interesting question. Because at the moment, the public psychiatric services, so the psychiatric services that are available for free in this country, very hard to access, unless you're extremely unwell. And actually, at the moment, I'm finding the private services are really difficult to access because the waiting lists are so long. So I'm actually doing my best with probably cases that I would, maybe 10 years ago have, have not been happy to look after because I would have felt they were above and beyond my remit. But now I, I sort of feel like I've i Yes, I understand the medication. And I'm not afraid of using an anti psychotic as well as depression tablet, or I'm not afraid of the medicine. So I'm happy to give things a go with people. And then also sort of just sort of take a step back and think of what what's the big picture here? Particularly because I know, I nearly always know the family. It'd be very rare that I don't know the family of whoever,
generally speaking, it's the whole family comes to the same doctor. It's not. Dad goes over here. Mom goes over here. It's yeah, yeah. Yeah. And that's not required. I should point out people aren't, aren't told you will go to this doctor. Unless it's the only doctor in town. Americans are more likely to be split up or always again, it will depend on geography to a degree and the healthcare insurance they have here that tells you a lot of things. Okay, that's one of the things I really miss about national health. Because here if you change your doctor, because your doctor may stop taking one particular kind of insurance, you go find another doctor. Fragmented care always is very, very frustrating.
Speaker 2 28:12
Yeah, yeah. Yeah, I the surgery I've been in now. I've been there for 15 years. So it's not my practice. I work as an employee of the person.
There we go with another that she means her doctor's office. That's what they call the surgery.
No. I call it the surgery. Did I
did it if that's okay.
And yeah, we call it the surgery. So funny.
It is we go back in the day used to do it there too, in the office, on the kitchen table, and my mom had her tonsils out and the kitchen table a long time ago in the Isle of Wight, in the 30s
Wow, yeah. Old school for 15 years. So I know. I know that people 15 years and I know, I know the hard things that have happened to them in their lives. You know, I know, the women who lost a baby at birth. I know. The man who lost their job whenever and then had to find something else. I know. Like those stories are kind of murmuring around in the back of my mind always whenever I see them with a problem but and they they're not always relevant, but
they color what's happening. They always do.
It makes a difference to me seeing that person as as a as a human being, who's lived a life with ups and downs as we all do. I mean, there isn't anybody I say it to everybody. Everybody that sits in that chair with me, including me will have had their ups and their downs in life. That that's that That's life, we navigate that together is, as humans do you know? So? Yeah, but it does, it does definitely make. It makes my job hugely enjoyable. Yeah. Like, I look forward to seeing the people, you know, it's like, oh,
it's such a such a pleasure to hear a doctor saying they're excited about their job, enjoy what they do, because I think most of us want to have I've been retired for a long time, but the younger members of my community, I think they're just so tired. Yeah. Do you think this is true of the people in working in the hospital outside of the general practice? You think the specialists likewise feel that because they don't have that same connection? They see people for specific things? And some of those things can go on for many years. But they don't have that connection through the entire family? Phenomenal memories? Yeah. Do you? Do you see them being more burned out?
No, I'd say it's, it's definitely equal across both general practice and the hospital medicine, feeling of being tired. The feeling of being asked to do too much the feeling of the feeling of this is all just overwhelming is definitely in both sections. I think I'm really lucky that because I've done all these other trainings, I can use these trainings to help myself on a daily basis.
Looking remembering what I read, before we started this, your bio, you said, you're teaching now you're teaching your patients? Do you teach junior doctors? Do you have people rotating through your office? So how do you think we could propagate this idea that it's integrative medicine that we need to be practicing?
So really just telling as many people as possible, do, you know, so one of the So Wayne Dyer, the famous American gentleman, who wrote lots of lovely books, I read a thing that he had written about how when he put his two feet on the ground every morning, he would be thinking about what the day ahead he was going to have and how it was going to be a great day or whatever he was setting an intention. And when I go into work, if I say to the girls at the front desk, we're gonna have great day to day. And if I don't say it, the girls will be like, Fiona, you didn't say it, you didn't see
what's gonna happen Fiona?
But actually, those sorts of things from all the other bits and pieces that there's so much interesting thought and interesting ideas out there about things that help us. And if we could spread those ideas that would be that would be great d'you know. And they're doing research now into intention setting, and how intention setting changes, that your neurons will start looking for ways to make whatever you've set your intention on happen, you know, so I do feel when it comes to our colleagues, we need the science to find that, that science, and where's the research being done, and so you can say, Okay, this is a nice thing that I do, I put my feet on the floor, and I say, Today's gonna be a good day, but then to be able to say, but actually, they are doing research into this. And they are finding that that this work, so to have some balance between the nice things that we might do that might actually help us feel better. And then the research that's that's there
Anecdotal evidence can only go so far.
Unknown Speaker 34:07
Yes. Yes, me telling them the story that it makes me feel good really isn't going to be enough. And I understand that.
Thank you very much. Before we go, I would love for you please to tell us a little bit about your website and how people can contact you if they want more information. I am assuming you would be generous and allow American doctors to contact you and ask you about what you're doing. Yeah,
absolutely. We I actually teach online every every Monday and Tuesday evening,
which will be afternoon or beyond, of course, time difference,
exactly what we're setting it up so that that those classes can be they're going to be recorded so that people can watch them in their own time. And there's themes to each month and it's not just mindfulness. There's a bit of NLP in there. There'll be visualization, anything that I learn, I will stick into those classes. So we're sort of building up a community of people that we're all sort of learning together about how to feel well,
is it? Is it for the general public? Is it specific to doctors, it's general public. If anybody who's breathing on the planet and can get on the internet is welcome to join you. Okay, very much.
And it's called Wellness UR Way. https://www.wellnessurway.com
it'll be in the shownotes people will find it. But that's great. Thank you so much. It was so nice to have you join me today. I look forward to talking to you again soon.
Thanks a million. Bye. Bye.
Thank you for joining us at Myth, Magic , Medicine. If you found this episode useful, you can apply for free CME credits for the link provided in the transcript. If you're not a medical professional, please remember, while we're physicians, we're not your physicians, so please consult with your own healthcare professional if you think something you have heard might apply to you or a loved one. Until next time, bye bye
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