Twelve Questions: Dr Sue Fleming

Sue Fleming says she has often been pulled between her career and being a mother. Photo / Brett Phibbs

Dr Sue Fleming is director of women’s health at Auckland District Health Board. She has been a trailblazing leader in the traditionally male domain of obstetrics and gynaecology.

1. When did you know you wanted to be a doctor?
In high school. I shared my ambition with a maths teacher who I really admired and looked up to as a mentor. He was absolutely dismissive, counselling me that girls are nurses, not doctors. Rather than discouraging me that made me determined.

2. In 1980 you became the first female clinical superintendent of women's health at Sydney's Royal Prince Alfred Hospital since World War II. Did you encounter sexism?
Being taken seriously as a woman with authority dealing with a largely male staff was challenging. There wasn't anything specific, but it was more in the way you're treated and regarded and at times left feeling diminished.

3. When have you been low, and how did you pull yourself out?
I've felt constantly conflicted between my career and being a mother; there were many times when I felt I did neither as well as I would have liked. Probably the hardest time was when my daughters were in late childhood and early teens. My 8-year-old girl had been assaulted on our street, and I felt terribly guilty about not being as available to my family as I felt I should be. Around this time my husband, a geologist in the exploration industry, was offered a job in America. This allowed me to have a break from work, be the at-home parent and spend quality time with my girls.

4. During nine years out of medicine you got an MBA and a diploma in IT. You chose to return to medicine as a trainee doctor. What was that like?
It was the best decision I could have made. I found it physically hard work, especially night shift, but it gave me a unique insight into our training model which has served me well as I've moved back into leadership roles.

5. What have been the big medical advances in women's health?
Birth has become progressively safer to the point where maternal deaths are now very rare events. We're seeing women go through pregnancies with complex medical problems that wouldn't have been possible even a relatively short time ago. I think sometimes we forget that. We're also at a stage where we're questioning our level of intervention.

6. Are we doing too many C sections?
We've seen a cultural shift which has resulted in a loss of confidence in birth. We want women to feel safe and empowered to think about pregnancy and birth as a normal life event; supported as necessary by the might of what we have to offer but not limited in thinking about their options. In gynaecology, we're doing a lot less surgical intervention. Hysterectomies have really declined and we're doing more procedures laparoscopically such as managing heavy menstrual bleeding, which accounts for about 20 per cent of women referred to us.

7. In which areas has research not advanced?
Our progress in the area of pre-term birth is much less impressive - predicting those women who are going to deliver early and preventing that from happening. There's a whole raft of cases where we don't have specific diagnoses as to why that happens.

8. Despite all the advances, birth can still sometimes go wrong. What's your opinion on the way the media handle such cases?
In this day and age, the idea that you could fall pregnant and the outcome could go so wrong that a healthy mother or baby could die seems inconceivable. And yet things can go wrong, and very quickly - even with the best care in place. That's the small but terrifying risk that you take when you embark on a pregnancy. The chance of maternal mortality in New Zealand is 15 per 100,000. Bad outcomes and heart-wrenching stories will always gain attention, but I think headlines contribute to women and their carers feeling fearful about childbirth. Clinicians have a responsibility to contextualise the risk for women without frightening them. In the UK they've done a huge piece of work called the Place of Birth study and produced some standardised information on risk that's simple and easy to understand. We don't have that in New Zealand yet.

9. How did the National Women's Hospital scandal in the 1980s affect your profession?
I think it caused clinicians everywhere to reflect on the way we deliver care and our responsibilities around communication. There are some real positives in having patients' rights so clearly specified in New Zealand. Independently of that, society in general has evolved towards consumers wanting to be more informed and involved. We've transitioned from the days when the patient would say "Doctor, tell me what to do", to people wanting to be part of their care planning. I've found "Dr Google" very helpful in terms of being able to have a conversation with someone who has done some research and has some understanding about what their health challenges are.

10. What are some of the challenges within New Zealand's current health structure?
There's a tendency for district health boards to work in siloed ways, in isolation of each other. So patients can, in subtle ways, receive different care depending on where they live. That can make it confusing for women and GPs. We're doing a lot of work on improving collaboration with Waitakere and Counties Manukau DHBs, finding ways we can pool resources and streamline the patient experience. We've forged really strong, trustful relationships that have enabled us to have some important and sometimes challenging conversations about ways we can develop uniform clinical approaches.

11. What do you enjoy most about your job?
I spend half a day each week doing clinic work and I have to say it's the highlight of my week. It's that privilege you get as a clinician of sharing with your patient and helping them solve an important challenge in their life. Direct patient contact keeps me real. But balancing that, my passion is enabling this service to be New Zealand's shining light in women's health. National Women's Health has been special in the way we've critically looked at our outcomes over a long time. We invest deeply in making sure the information on what we do is reliable and trustworthy. We hold an annual open day and invite external critique and then put that information in the public domain.

12. Do you think society is hard on women as we age?
In truth, I've mostly enjoyed the benefits of age. I'm very happy to be the other side of menopause and no longer subject to the ebb and flow of my hormones. There's much to be said for the steady state that men generally enjoy.