Introducing Professor Ted Weaver OAM

Professor Ted Weaver OAM is an obstetrician and gynaecologist based in Queensland. He served as the RANZCOG President from 2008-2010 and has been involved in a number of College committees. He has held academic positions at Griffith University and the University of Queensland and has been awarded an honorary Fellowship of the Australian College of Midwives. In 2016, Professor Weaver was presented an Order of Australia Medal recognising his services to medicine and medical education.

What might be useful for a junior doctor to know about how to get stuff done?

When starting off in your career, it is important to remember why we practise medicine in the first place. Think about what a unique position you are in, the trust people will put in you, their vulnerability, and the importance of safe, quality healthcare. Medicine can be gruelling at times, so self-care is really important!

That means, for you:

• Work in your role as part of a team and be a contributor.
• Be punctual and remember humility is a cardinal human virtue.
• Make sure every activity with patients is professional.
• Don’t diss on your colleagues.
• Don’t procrastinate.
• Don’t second guess – if you are not sure, seek clarification.
• Listen carefully and document contemporaneously on ward rounds/patient interactions.
• Use recaps to check your understanding of the patient’s problem.
• Develop good prioritisation skills.
• Celebrate successes.
• Share your failures with colleagues and don’t be afraid to admit you made a mistake.
• Develop interests outside of work and lead a healthy lifestyle.
• Develop a mentor and use them.

Did you always plan to become an O&G?

No, it was ad hoc. I had an idea that I wanted to be a procedural country GP and set about training myself for that, until I did a year as an O&G registrar and got hijacked!

My whole career has evolved as I got older and developed new interests. I never had a plan of where I wanted to be in five years or 10 years and am really happy with where I have landed.

Did it go according to plan?

No, as above. I thought I’d give myself one go at the then first part of the membership exam and if I passed, I’d continue. I passed and I kept going!

Initially, I started training in the UK and then did the last four years in Queensland, until I elevated to Fellowship in 1987. I was appointed the inaugural Director of O&G at Nambour Hospital, then the main hospital for the Sunshine Coast region. I held that role for three years, then ran my own private practice for 25 years. I went back to public medicine in 2011 and took on an academic role with the University of Queensland Medical School.

Any unfinished business?

Plenty! The main issues vexing me at the moment which I am trying to make progress on are, in no particular order, adverse maternity incidents and how we might reduce/prevent them, severe acute maternal morbidity and ways to reduce it, maternity models of care, free birth and how we might reach out to those women, reducing inequities in perinatal outcomes in First Nations women, and practice standards in both obstetrics and midwifery.

There’s a lot of work still to do!

Do you think there was someone who inadvertently changed the trajectory of your career?

Yes. Professor Maurice Webb was a gynaecological oncologist who came back from his role at the Mayo Clinic in Rochester, US, to run the inaugural gynaecological oncology service in Queensland. Maurie taught me many things:

• how to operate in the pelvis safely
• how to get myself out of trouble during gynaecological surgery
• why clinical research matters
• why standards are important
• why it is important to question orthodoxy
• many other life lessons.

He only told me things once. I owe him a lot.

Leadership in medicine often depends less on having the best idea than convincing others to trust it. How have you learned to bring sceptical people with you?

By engaging with them, sometimes over beer or wine. In vino veritas! Finding common ground and discovering how their views have developed is important. Generally, people are on the same journey as you, just in a different part of the caravan.

Being the President of RANZCOG meant representing a diverse range of members. How did you decide whose voices to amplify?

There was always plenty of wisdom in the room when I was on RANZCOG Council and in the President’s chair, plus I had a network of colleagues and mentors whom I liked and trusted.

Often the loudest voices in the room were people who rarely contributed, who were naysayers, and were not interested in any progressive agenda. I found the best way forward was to listen to everyone and then follow an old Irish dictum, “Agree with everyone, but do what is right!”

What’s a decision that looked obvious from the outside but was incredibly complex once you were in charge? What issue kept you awake at night?

Maternity reform was slow to come in Australia. I always have had good collaborative relationships with midwifery colleagues, and I felt we could strengthen our collaboration with the midwifery workforce. I was quietly proud when I was made an honorary Fellow of the Australian College of Midwives in 2002 for developing collaborative models of maternity care with midwives.

When I was on the RANZCOG Council in the early 2000s, Aotearoa New Zealand had recently introduced their lead maternity carer (LMC) system, which enshrined midwife led care. The New Zealand College of Midwives were very politically active, and the Australian College of Midwives were inspired to pursue a similar agenda for change. When the Maternity Services Review was introduced by then Health Minister, Nicola Roxon, RANZCOG presented a coherent case for collaborative maternity care.

This was a complex set of negotiations, as we sought to balance the needs of public and private practising Fellows, GP obstetricians, midwives, and the women we cared for, without sacrificing safety and quality of care.

The negotiations resulted in midwives having access to the Medicare Benefits Schedule if they were involved with collaborative maternity models with a doctor, the creation of the “eligible” midwife role, and different and enhanced models of care for women.

Overall, I think this model has resulted in more choice for women, an improved career path for midwives, and better collegiality between obstetricians and midwives.

The negotiations and all the issues about this kept me awake at night!

If you had unlimited funds, how would you redesign pregnancy care in Australia from the ground up? Any great ideas for workforce planning?

I would ensure that women have maternity care close to where they lived – regardless of postcode. It would be collaborative, involving a known midwife for the mother, and close collaboration with the doctor, so the woman could get “the right care, at the right time, in the right place, by the right person.” Care would be woman-centred and tailored to the woman’s individual needs.

I would aim to provide improved antenatal education, ensuring that women and their families are well-informed of the reality of what can happen during pregnancy, labour, birth, and during early parenting.

Labour care would have more involvement of consultants present on the birth suite 24/7, to ensure labour management is safe and evidence based, that CTGs are interpreted correctly, operative births are performed safely, and CS avoided where appropriate.

I would publish every maternity hospital’s outcomes to enable women to have accurate information about an institution before going there for care. This should be an integral part of a woman’s choice.

I would better resource postnatal care, with increased home midwifery visits, breastfeeding support, early parenting and perinatal mental health services for mothers and caregivers, better management of perceived birth trauma, and much more.

It deeply concerns me that about 20% of presentations to paediatric DEM after hours are new mothers who can’t feed or settle their babies. I would develop mother/baby hubs where women could get advice and support 24/7 for these sorts of problems.

What is your advice for clinicians wishing to be involved in advocacy?

Remember we elect governments and politicians, and we should raise issues of concern with them often. Ask difficult questions in public forums and be involved with your local community. Politicians inhabit a complex landscape of many competing priorities. Focus on incremental progress which can bring meaningful change.

How did you avoid burnout? (Did you avoid burnout?)

I don’t think I know what burnout is. When I finished my term as President and had been away from my private practice, I was admirably supported by my fantastic consultant colleagues (thank you!). I realised the demands of my practice were such that I was sick of the grind of it, so decided to move back to public practice and do clinical practice, teaching, and research.

I sold my private practice to a new FRANZCOG, and the practice is still flourishing under her excellent leadership. I forged a new career back in public work and have been doing other interesting things in medical education, as well as heading up the Queensland Maternal and Perinatal Quality Council.

I get tired at the end of a day but always wake up ready for the next. I really like what I do, and burnout has never been a thing for me. Having said that, I am ready to retire and have new adventures!

I have been blessed with a happy homelife and great family who have been very supportive of me, and who have not resiled from telling the truth! That has kept me grounded and sane, and I owe them a great debt.

When your grandchildren – or a trainee who has never met you – look at Australian maternity care in 20 years’ time, what do you hope exists because people of your generation decided it mattered enough to build it?

I want maternity care to feel safe for women, and for women to be able to access team-based care that is not ideologically driven. I want a well-resourced health system that provides women’s healthcare across the spectrum of their life, where women can access evidence-based, affordable, and quality care.

I want us to value our new mothers and babies and have pre-conception, pregnancy, early parenting, and workplace programs that are women and family centred.

I would like us to finally close the gap for our First Nations peoples in maternity care.