Interview with Dr Jesse Zanker FRACP

Dr Jesse Zanker is a Geriatrician working in Echuca, Victoria. The Support for Rural Specialists in Australia (SRSA) grant enabled him to attend The Executive Colloquium at the Cranlana Centre for Ethical Leadership. The Colloquium is an ethics and leadership course examining how the health and aged care sectors can apply their services more justly.

Dr Zanker kindly spoke with the SRSA team about his career, the challenges and benefits of working in a regional area, and his experience with the SRSA Program.

Can you tell me about why you became a geriatrician?

I always wanted to be a paediatrician until I worked as an intern on an aged-care rotation. It was then that I realised it was something I loved but had never had much exposure to. It appeals to me because it is a great intersection of human rights and individual ethics. I like understanding how this fits within medicine from a biological and psychological perspective, as well as within society and the family unit.

It is also one of the few specialties where you get to have with more time with individuals and their families. I take an hour and a half for appointments – there are very few specialities that get to do that. I provide comprehensive reviews and need to understand the details in the context of their values and preferences. I then try to match the recommendations with what they are trying to achieve. Everyone is quite different. It’s very patient-centred and goal-oriented.

Geriatrics is also a generalist specialty, which is a bit of an oxymoron, but it is. It applies very well to rural and regional settings, which is where I knew I wanted to work. I also think geriatrics is an area that has been neglected for a long time. It’s not a heavily sought after specialty, but I think there’s so much to be gained from it. There’s so much need there. While a lot of specialities are single organ, in geriatrics we treat not just the organ, but the person that has the organ.

Why did you decided to live and work in a regional area?

I grew up in Echuca, Victoria (MM3) and that is where I predominately work now. I did work experience when I was a medical student with the GPs there and I always felt very supported by them and others within the community. I don’t come from a medical or academic family. After I graduated I felt a sense of duty and was drawn back to working there.

What are the top three challenges you face working in a regional setting?

There are many challenging aspects. Professional isolation is an issue, as it is with all specialists living in these areas. We are not exposed regularly to the latest knowledge and research by virtue of that isolation. For me, it helps that I have regular case conferences with other geriatricians in Melbourne. I often find that I see people with more complex cases than they do. This is because people in rural/regional areas often go longer without seeking treatment, or have not had specialist input on rare or complicated issues. It’s a very different patient mix out in the country.

The majority of my work are cognitive assessments. I try to work out the diagnosis and plan with the patient and family around the diagnosis or uncertainties. This throws up a whole range of challenges because one the big problems we know about older adults is social isolation. A diagnosis of dementia for someone living in a rural or regional area is devastating. It often means there are issues with licencing and driving, which increases their isolation. Guns are also an issue with cognitive diagnoses. Firearms are an important part of some people’s liberty. It’s a matter of weighing up what is important to their liberty and what’s required by law. Communicating that to their families and planning around it can be really challenging.

A unique challenge that I didn’t anticipate is how many people I would see in the country that are illiterate or innumerate. I did most of my training in the Western suburbs of Melbourne which is a different population. Dealing with illiteracy was not part of my training. I had to learn what is an appropriate cognitive assessment for someone who is illiterate. I needed to reframe my approach completely because there are great sensitivities around this.

What are some of the professional benefits you get out of living and working in a regional area?

I think my scope of knowledge has broadened. An important part of medicine is that we are always learning, but I find myself looking things up more frequently than I anticipated. I come across things that are a bit more uncommon or rare, or I hadn’t seen as often when I was training in the city.

I also get called on to do a range of different things in my work. I often deliver talks to staff at nursing homes or provide training sessions for carers of people living with dementia. I was interviewed for the local newspaper recently. It is a different experience compared to my colleagues in the city who have a narrower scope in what they do. For example, they might work on a rehabilitation ward and don’t get the continuity of care after the patient leaves. But for me, I get to know people well as I review them over months and years. These are things that make me feel really enmeshed within the community. I find it very rewarding.

How did you find out about the SRSA program?

I saw it advertised in an email, I think it might have been the Royal Australasian College of Physicians (RACP) newsletter.

Why did you decide to apply for funding from the SRSA program?

I was nominated to attend The Executive Colloquium at the Cranlana Centre for Ethical Leadership. I wanted to attend but it was financially difficult as I am working part-time at the moment because I am doing a PhD. The SRSA grant provided me with the opportunity to attend.

Can you tell me about the CPD activity you undertook with the SRSA grant?

The Executive Colloquium is an ethics and leadership course looking at how we can apply our services more justly. I think there’s no better application of this than in rural and regional Australia. The Colloquium was with about 12 other people, mostly CEOs of large organisations from a range of health care and aged care sectors. I was very underqualified for it! It was great to be able to learn from them and make connections. It was one of the best educational experiences I’ve ever had. I regularly reflect on the things that I learned.

Can you describe how the CPD activity improves patient outcomes/benefits the community

Medical practitioners regularly face ethical decisions and I think this is particularly so in geriatric medicine. I work with people who are at a point in their lives where we need to weigh up risks with liberty; while respecting individual values and preferences, and also incorporating what the family wants. This is a constant tension in geriatric medicine. The Colloquium has given me the ethical tools to better manage this process. I feel more comfortable in the decisions I make to try and improve patient outcomes.

Would you have done this CPD activity without a SRSA grant?  

It would have been difficult for me to afford. I was very grateful to be offered the funding.

What are your plans for the future?

In the foreseeable future I plan to stay in Echuca. I don’t want to establish a service and then remove it. I want to continue working clinically and I also want to develop an academic career as well.

My goal is to always have a connection to rural and regional Victoria. I also aim to increase the number of people working in geriatrics in these areas. I’m on the State committee of the Australian and New Zealand Society of Geriatric Medicine and I’m trying to use levers there to promote rural geriatrics practice. I’m also trying to establish a range of different clinics, such as a clinic for cognitive assessment for Aboriginal and Torres Strait Islander elders, and getting other people trained to deliver these services as well.

Do you have any advice for other rural specialists?

I believe that professional isolation is what you make of it. There’s always resources out there that you can access so you can continue to be a life-long learner, such as the SRSA grant. It’s also important to establish and maintain connections with your colleagues and the community. It’s possible to do, it just takes a bit of effort.