[00:00:00] Mat: Welcome to Doctors at Work. My name’s Mat Daniel and this podcast is about doctors’ careers. Today, I’m talking to Anne Eason about audio vestibular medicine. She tells me what audio vestibular medicine is like and what skills you need to get in. She shares the importance of being a good listener and explains how she loves unpicking complex issues to arrive at a diagnosis and then a treatment plan.
Hope it’s useful.
Welcome, Anne. Tell me about yourself.
[00:00:41] Anne: Hi Mat, so I am an audio vestibular physician. I work at two hospitals Derby and Nottingham. I do an 80 percent job, so eight PAs currently sat in Nottingham. Yeah, so that’s me in a nutshell, in my, from a work point of view.
[00:00:56] Mat: So how did you get into audio vestibular medicine?
[00:00:59] Anne: I was on an ENT training programme, but I knew that wasn’t going to be my long term path. And I was trying to work out where, where I would be best placed. And I looked at doing a law degree, because I was interested in doing law and medicine as a combination. I looked at GP but decided that definitely wasn’t for me.
And then one of my trainers in Manchester had a previous trainee who’d gone on to be a consultant in audio visible medicine. So it was something he knew about and he thought it might suit me quite well. And so I went to talk to that lady who were, who was a consultant in the Northwest, and I also went to talk to the training program director, and that’s where my interest came from.
And then I went to do I sat in on some different sessions that were relevant to audio Medicine, children’s, paediatric audiology, adult sessions and just decided I was really interested in it and looked at the training program. It was another five years, so at that point I’d done, I done a fair bit of e n T, but I was interested in it and I felt it’d be a really good job that would suit me.
So that’s where it came from. Basically, that was my path, beginning of the path into it.
[00:02:07] Mat: So what actually is audio vestibular medicine?
[00:02:10] Anne: So essentially it’s hearing and balance medicine. So anything to do with that tiny little, part of the bony structure in your head the labyrinth. So anything to do with your hearing or your balance or tinnitus.
Yeah, so from, and the good thing, the thing I liked about audio vestibular medicine was you trained in peds and adults. So you trained from when, from when you were born, newborn hearing screen all the way up to. Balance problems and tinnitus problems in the elderly. So that was really interesting ’cause we covered everything.
And it’s very multidisciplinary. So the training, which is five years, you have to do community paediatrics you have to do paediatric and adult ophthalmology. Neurology, you do psychology, psychiatry. So it’s a really broad based training program, which was fascinating because I knew little bits obviously ’cause I’d done ENT .
But I, you don’t know what you don’t know. And there was so much that I had to learn. It was fascinating and all the different, the basic sign language and all the different aspects that I got to see, schools for the deaf and learning from the teacher, the deaf all sorts of different aspects that I was exposed to that I was interested in.
So it, it was a really interesting training program that I can definitely recommend.
[00:03:19] Mat: So what kind of patients and conditions do you see?
[00:03:23] Anne: So essentially anything to do with hearing and balance from newborn children all the way up into adults. So for children paediatric audio vestibular medicine, there’s a lot of work on aetiology.
and causes for deafness and then children who develop deafness, genetic forms of deafness balance problems in children and that’s probably the majority of what we did in children. We did quite a lot of tinnitus work actually as well, I’ve forgotten that and then for the adult patients, common causes of dizziness, multifactorial disequilibrium, trying to identify why people are off balance, whether that be neurological or, whether it’s vestibular or whether it’s a combination of lots of things.
And then tinnitus patients and hyperacusis and hearing loss. Yeah. So that’s probably the main bundle of what we do.
[00:04:13] Mat: And what kind of skills do you need to succeed in audio vestibular medicine?
[00:04:19] Anne: I think you need to have an analytical brain. You need a fair degree of patience because you have to sit and listen quite a lot and try and pick out what you need.
It’s a little bit like a, especially for balance problems, it’s a bit like a Poirot episode sometimes, trying to work out what’s wrong. So you probably have to have a brain that likes unpicking problems. Yeah, so I think probably good listening skills, analytical brain and liking problem solving and liking things that are complicated.
So it wouldn’t suit someone who likes quick things that are quick to sort out and, done and dusted. It’s usually quite complicated and you have to see people a couple of times. Now, I find that really rewarding, but, you’d have to have that kind of personality. Obviously, some people in medicine would have a different personality type and, that wouldn’t suit them.
[00:05:07] Mat: And how do you get into audio vestibular medicine?
[00:05:10] Anne: So to get into it, it’s different now. I looked this up. So now to get in, you need to have done your MRCPCH , your MRCS ENT or your MRCGP . So essentially have done internal medicine stage one, paediatric level one training, GP practice training, or core surgical training in ENT.
And that’s how, that’s the, that, then you go into selection and you go for an interview.
[00:05:35] Mat: Okay so any of those things will get you in?
[00:05:39] Anne: So any of those things will get you in and then you do an assessment process. is essentially an interview. And then you do four to five years training, depending on how much you’ve done before you start.
And I think the GMC are trying to decrease that to four years.
[00:05:59] Mat: So what do you need to do in order to succeed at that interview?
[00:06:03] Anne: I think you need to show interest basically. So before the interview have done some taster sessions or some clinics or have a reason why you are interested in the speciality.
I think at interview communication skills are important, and that’s an important part of the assessment process, and I’ve done the interview panel, and that’s something that, obviously, particularly in our specialty, is useful. You may need to explain to parents why children are deaf, that sort of thing, so there’s a lot of communication skills.
Obviously, I’ve fulfilled the criteria. And then I think if you show an interest and you communicate well those are the basics for what you need to do.
[00:06:43] Mat: And what do you as a consultant spend your time doing?
[00:06:47] Anne: So essentially my week is clinic. So I do five clinics in a week outpatient, totally outpatient based, and I either do telephone or face to face appointments a mixture of news and follow ups, basically trying to…
establish what the problem is with hearing or balance. I currently mainly do adults. So what the problem is with their balance, what the problem is with their hearing or what the tinnitus issue is, how severe, how severely they’re affected if it’s tinnitus. And then we do an MDT every three months. So a balanced MDT, just looking at One of our really complicated patients.
So we do that with the audiologists, the vestibular physios, and one of my colleagues who’s ENT with an interest in balance. So that’s really useful and we share ideas there. The latest thing that we should all be looking out for doing. Yeah, so the majority of my time is clinic or MDT and I’ve got a trainee as well.
Training him, trying to. trying to help. He’s an ST4. So he’s relatively new. Yeah. So that’s my week. It’s clinic and I don’t do any on calls. I don’t do nights or weekends, which is one of the major benefits of this specialty. Yeah, and it’s good. I enjoy it. I enjoy what I do.
[00:07:57] Mat: What are the challenges?
[00:08:00] Anne: Specifically, I think probably history taking in complicated patients, often with memory problems and, anxiety. So challenges with history taking challenges with trying to see enough patients, but that’s probably not just specific to what I do. There’s too many patients and not enough doctors, but that’s normal, isn’t it?
Admin, trying to get my admin done in time. I feel like, that is a permanent problem, whether that’s specific to me or everyone else. I think that’s probably quite standard. Yeah, I think it’s a lot of the issues that I have are probably fairly, it, probably fairly standard for everyone else, but specific to what I do and listening, actually, it can be, it sounds a very.
Simple thing to say, doesn’t it? But listening can be very tiring, particularly when you’re listening to people with complicated histories and lots of psychological, issues going on in the background. It can be quite tiring at the end of the day, not as tiring as lots of people doing complicated A& E work or, theatre and emergencies, but there is a fatigue in listening intently.
[00:09:07] Mat: And what are the best bits of the job?
[00:09:09] Anne: I love working out what’s wrong. If you can actually work out what it is and sort it out and they get better, great. Or even if they don’t completely get better, if you can identify what it is and give. What’s wrong with them and then some tools to try and manage it.
That’s really rewarding. I like that, it is rewarding and they’ve often gone through lots of different services who just simply haven’t had the time to unpick it all. So if I can unpick it and work out what it is. I enjoy it. I get, I get a reward from that because they improve and potentially that, particularly the older people I see, they’re not going to fall over.
They’re not going to be the, 50 percent who die within six months because they fractured their hip. If I can stop them falling over and stop them being dizzy, or at least help with that process, that’s Rewarding part of my job.
[00:09:52] Mat: I really like this idea that people have rotated through multiple different specialties and no, nobody’s quite had the time or the enthusiasm or the energy to put it all together, whereas, what you’ve outlining is that your specialty, you take the time.
And you clearly have a very broad based training and you pull all of those bits together. And I can certainly see how that would be very rewarding, particularly, as you said, if somebody who’s got a mind that is, that likes problem solving, listening and detective work.
[00:10:23] Anne: I do. And I should probably say it’s unfair maybe to other specialties, because I sit, I have half an hour appointments to see my new patients, when I did those at patients in ENT, you’ve only got 15 minutes, so it’s really difficult, some of my elderly patients, it can take 15 minutes to get them unchanged to examine them, so I have longer times to try and sort things out, but I’m very much, I think if you do it.
It’s quality, it’s quality, isn’t it? If I can do it and do it properly and unpick what’s going on, that might save lots of other people having to do it. And often it’s finding out that it’s a cardiac problem, that they’ve got palpitations or they’ve got postural hypotension or.
In fact, it’s neurological or it’s nothing to do with their vestibular system, but that’s my training to try and work out which bit it is, which obviously I don’t always succeed at, but sometimes I do and that’s useful because then they stop coming back to ENT over and over again and they go off to wherever they, they have their pacemaker and I don’t get any more dizzy spells.
[00:11:21] Mat: Yeah, fantastic. And my final question, what would be your top tips for doctors thinking about their own career decisions?
[00:11:30] Anne: I think there are I think what I learned from my training, because I did a lot of ENT and then changed, and I think You need to begin with the end in mind, which is very difficult.
But if I was going to talk to younger doctors, I’d tell them to try and find their tribe of people they are like, because you go around, you do all your different specialties, and you find people who you fit in with. And then I think you need to try to begin with a lifestyle end in mind. So I really enjoyed when I did A& E.
I really enjoyed that. I didn’t want to do that as a lifestyle because it just wouldn’t have suited me. And likewise, I enjoyed ENT, but I didn’t want to do on call. So I think if you can try and work out what lifestyle you might like, then that is quite a and fine. find a tribe that fits in with that, then you might have found your specialty.
Because I think when you’re young, it’s really exciting to do loads of, highly intense, interesting things overnight. And then as you get a bit older, that can be a little bit less interesting. And if, and whatever your, or if you really enjoy that, then you carry on doing it. But I think I’d try and begin with the end in mind in a strange way.
[00:12:47] Mat: That sounds like great advice. Thank you very much, Anne.
[00:12:51] Anne: You’re very welcome. Thank you, Mat .