Pathways through medicine

In 2006, as a medical student, I sat in the corner, probably in a small children’s chair, of Dr Adam Scheinberg’s Cerebral Palsy Clinic at Kids Rehab at The Children’s Hospital at Westmead.

A heavily tattooed father with a ZZ-Top beard, leather jacket and no shirt underneath, attended with his 11-year-old son. This gentle boy had cerebral palsy, which was affecting his ability to mobilise due to spasticity. The tenderness also of the father towards his son (despite his tough appearance) struck me as poignant. That moment brought home to me the possibility that I might be able to make this field of children’s rehabilitation my home and contribute to its development. This would involve bringing my background in neurophysiology, electrical and rehabilitation engineering to the table, at least in this boy’s case, to help solve some of the mysteries of reducing spasticity in children under eight to minimise orthopaedic problems.

I believe this was the point at which I knew I could invest the 12 years of prior post-doctoral experience in improving hand function in people with tetraplegia to a broader and very vulnerable patient group. This was a defining moment guiding me towards a career in paediatrics focussing on neuromuscular and musculoskeletal rehabilitation.

Early inclinations

I can’t claim I didn’t know what I was getting into. Coming from a medical family (my father, Dr Ron Scott is a general practitioner), the on-call phone was a part of our living room sitting in the corner like a white bat-phone. The disruptive ring demonstrated that, for the on-call doctor, evening relaxation could be replaced in an instant by a situation requiring active response and vigilance. Nonetheless, the privilege of the situation, including the ability to influence the lives of many for the good, made an impact and stayed with me. Relative strengths in maths and science at school and an enjoyment of computer coding probably took me to engineering as my first degree. However, I saw biomedical engineering as means of satisfying my proclivity towards clinical influence whilst using the engineering training. With most biomedical engineering advances appearing to be interfacing electronics to the nervous system (such as cochlear implants and pacemakers), I sought to gain experience in the manipulation of the nervous system. Following two years of electronics R&D experience in industry, this led to the undertaking of my PhD in Neurophysiology at The University of Sydney with Prof Max Bennett. On-campus networks and community, developed by Sister Mary Shanahan at Sancta Sophia College, led me toward an opportunity that would take me to the United States as a post-doctoral fellow with the best team in the world in their area of research. This was at Case Western Reserve University in Cleveland with the eminent Prof Hunter Peckham. The research area involved restoring hand function with electronic implants for people paralysed by a high spinal cord injury. This opportunity was a fellowship supported by the Movement Disorder Foundation of Australia. Subsequent to this, I arrived back in Sydney armed with the groundbreaking technology where, with colleagues Dr Claudia Gschwind (hand surgeon), Dr Sue Rutkowski (Spinal Cord Specialist), Ruth Quirk (PT) and Veronica Vare (PT), we formed the Quadriplegic Hand Research Unit at Royal North Shore Hospital. Prof John Morris was a great mentor at this time. Through our collaboration, we were able to implant a number of these devices, which were very successful, and undertake research contributing to improving upper limb function in those with disability.

With some modicum of success in clinical research, I found myself being taken out of the clinical lab and my primary work became grant writing and reviewing the work that others had done. This was not good on two fronts: firstly, I was taken away from the clinical contact that had been a great motivator and, secondly, I was proposing research concerning a group of patients, by nature of my increasing management requirements, about whom I was beginning only to see from a distance. A meeting with Prof Stephen Leeder, the Dean of Medicine at The University of Sydney helped me to consider that a career in medicine might put me back at the clinical coal face. This would be with a skill set that would allow me to impact the community of people with disability both through clinical work and the development of relevant person-focussed clinical research work.

Opportunity and aspiration

The transition points are always the challenge in a career – especially a medical one. Moving from medical school to internship, moving from resident to registrar, basic trainee to advanced trainee and advanced trainee to consultant. The increasing responsibility and expectation. Professors Kerry Goulston and Stewart Dunn taught me about the unique privilege of being a doctor. Dr David MacDonald in Port Macquarie taught me about the joy of paediatrics. In transitioning out of basic training, Dr Louis Cheung, our Director of Paediatric Physician Training, was a key person who was very generous to me with his time and advice. In making the transition from advanced trainee to consultant, I will always be grateful to my supervisors, Drs Simon Paget, Mary-Clare Waugh, Steve O’Flaherty, Adrienne Epps, and Michael Brydon who helped me greatly, and also to Ms Anita Fletcher of the Careers Service at the AMA who encouraged and supported me in being ready for opportunities as they arose and how to create them. My professional career has been built on such relationships and I have been the beneficiary of much thoughtful generosity from many first-class people too numerous to mention.

I remember a student of mine telling me that his goal was to become a self-made man. My feeling is that this successful self-made person doesn’t exist. In our lives, we all are beneficiaries of the trust and patience of many people. People who have been willing to believe in our hopes and our capabilities and invest individually to allow growth. I have been the grateful recipient of many opportunities given to me by such belief.

Research that makes a difference

I love the clinical environment. It is my habitat and my classroom. Each child that comes in teaches me. Given a background that is unusual amongst my colleagues, I feel a responsibility to make the best of the unique training and opportunities I have been given. I feel very fortunate to meet with families and work together to find the best path ahead. The multidisciplinary teams around me are inspirational with their commitment and dedication to the children and their families. With the opportunity of undertaking clinical work, I appreciate the opportunity to support my patients here and now and, with the research ongoing, look to improving their future. I am building my research momentum including an ambitious proposal for a Centre for Excellence in evaluating our interventions and translating our innovations into practice. Additionally, I am leading research in the area of 3D-printed prosthetics including co-design and virtual reality and in evaluation of interventions (including surgical) to the upper limb workspace in people with tetraplegia.

Achieving balance

I think what surprised me about a medical career was that the demands would be so visceral. As a JMO, sometimes learning opportunities would be lost in the volume of work required. It is hard to explain to the bright-eyed medical student, the fatigue of a 16-hour weekend shift covering the hospital, a week of night shift or a month on-call. Even here, there are lessons including the value of drinking water and eating lunch, prioritising work effectively, asking for help when you need it and carrying yourself with dignity and a cool head when under pressure. Hopefully, all these lessons add together now in my career: not only to influence the lives of families and their children with disabilities but also allowing me to get home to my wife, Monique, before bedtime for our four and two-year-old boys, Cameron and Lewis.

Dr Timothy RD Scott works as a Paediatric Rehabilitation Specialist at Rehab2Kids in Sydney Children’s Hospital and HNEKids Rehab in the Hunter New England Area. Dr Scott undertakes clinical work with children in the areas of cerebral palsy, limb difference, brain injury and general rehabilitation. He is appointed in the Department of Hand and Peripheral Nerve Surgery at Royal North Shore Hospital. He undertakes research in the area of rehabilitation and has a special interest in hand function in people with disabilities. His academic appointments include Senior Lecturer at the Graduate School of Biomedical Engineering and Medicine both at University of NSW and Clinical Senior Lecturer at The University of Sydney. He holds a PhD in Neuroscience and honours degrees in Electrical Engineering and Medicine.

Careers Service

AMA (NSW)’s Careers Service has assisted hundreds of doctors achieve their goals by offering professional support tailored to their level of experience, skills and ambition. For more information contact Anita Fletcher, Manager of Medical Careers Service, 02 9902 8158 or email careers@amansw.com.au.