Prof Hoffie Conradie, Navigating the Continuum of Care

In considering the landscape of modern healthcare, the conversation often centres around technological advancements, groundbreaking treatments, and cutting-edge research. In this episode of the Awakening Doctor podcast, Professor Hoffie Conradie, Emeritus Professor of Family Medicine and dedicated life coach and mentor, reminds us that the heart of medicine lies in relationships and continuity of care.

As we navigate his lifelong commitment to rural family medicine and unravel the many different threads of his personal life story, we discover the pivotal role he has played in defining rural family practice and medical education. We also learn about the fundamental values, influences, and experiences that have shaped his transforming identity as a white, Afrikaans man in a post-apartheid South Africa.

From grappling with the tenets of his religious upbringing to embracing self-compassion, we learn that continuity of care applies not only to the relationship between a doctor and their patient, or a patient and the health system, but also to the continuously evolving trajectory and dedication to service that is Professor Conradie’s career.

Join us as we explore his unique perspectives on teaching, spirituality, personal development, and the role of coaching, mentoring and Taking Care in the healing professions.

The Taking Care initiative offers courses that cultivate resilience and joy for healthcare professionals working with stress and burnout. Find out more here: https://www.takingcare.co.za/

Chapters

• 0:00 Importance of Doctor-Patient Relationship
• 4:23 Journey to Becoming a Doctor
• 11:16 Importance of Continuity of Care
• 22:29 Allied Health Professionals in Healthcare
• 30:31 Challenges and Realities of Medicine
• 35:06 Reflections on Rural Generalist Family Medicine
• 45:23 Evolution of Beliefs and Career Influences
• 1:01:19 Supporting Continuity in Medical Education
• 1:16:26 Importance of Coaching and Mentoring
• 1:20:56 Life, Family, and Medicine Journey
• 1:28:02 Reflections on Retirement and Responsibility
• 1:33:24 Learning and Growth in Relationships

Transcript

Prof Hoffie Conradie Guest 00:00

The emphasis of that course was so much on the doctor-patient relationship and here I was, virtually the only full-time doctor for 30,000 people. How on earth can you have a doctor-patient relationship if you have so many patients? And that sort of really caused an existential crisis in me. It said shouldn't I rather just go to private practice, where I can maybe do that thing of being the GP in a small town? I went through an interesting journey, because I really structured my work in that area where there were like 20 clinics that I visited regularly, but with the other doctors, later, that I worked with, we've kind of structured the whole system so that there's more continuity of care. So that whole patient-centered care really spoke to me and resonated with me. 

Dr Maria Christodoulou Host 00:59

I think there might be people listening who don't really know what that means. It's a term we use in medical education, but what does continuity of care mean for you? 

Prof Hoffie Conradie Guest 01:07

You see the same patient over time, regardless of the illness they come to or the problem they come to, and in state care it's often, I find, that people don't really see it as necessary, while in private practice it's given, you know, patients up here as the choice, but you see the same health provider. If you want to, you see the same one, you can make an appointment, and that's been quite a big theme in my life, that whole continuity of care. So when I left, I spent two years in canada in small rural area, a rural village where the road ends virtually where it's minus 30. And we were two doctors for 2,000 people and I worked there for two years and at the end of that I could virtually tell a story about everyone. When I see somebody in the mall, I knew virtually everyone. And then when I came back I did go into private practice in very rural places where I was also the government clinic doctor and the hospital doctor. 

Dr Maria Christodoulou Host 02:13

And was that sort of understanding of the importance of continuity of care Like how did you come to realize that this is what's important? 

Prof Hoffie Conradie Guest 02:22

It's somehow innate, because that's the relationship. For me, the important thing is the relationship with the patient, and that's such a big part of for me, of being a doctor. More important than making the diagnosis. 

Dr Maria Christodoulou Host 02:37

Welcome. I'm Dr Maria Christodoulou, and this is the Awakening Doctor podcast, a space where we discover the personal stories of those who work in the medical and health professions. Join me as I explore the hopes, the fears, the aspirations, and the real-life challenges of those who carry the title, responsibility and privilege of being a doctor. My guest on today's episode of Awakening Doctor is Professor Hoffie Conradie, Emeritus Associate Professor of Family Medicine at Stellenbosch University and an experienced family physician and health sciences educator with a lifetime dedicated to rural family medicine. A passionate life coach and mentor to colleagues and students alike, and co-founder of the Taking Care Initiative, which I will let him tell you about a little bit later. He's also a keen cyclist and nature enthusiast. 

03:34

Hoffie was instrumental in the establishment of the Ukwanda Centre for Rural Health, pioneered the first rural clinical school for undergraduate medical student training in South Africa, and has been extensively involved in postgraduate family medicine training programs, and building teaching capacity in district hospitals across South Africa and beyond. I've had the privilege of working with Hoffie in various capacities over the last 15 years and I've come to know him as a man who is deeply committed to community-oriented, person-centred medicine. A man who embodies servant leadership at its best. Welcome, Hoffie. It's lovely to have you with us here today. 

 Prof Hoffie Conradie Guest

 It's lovely to be here. Thanks Maria and Amy. 

 Dr Maria Christodoulou Host

 Also in the room. With us is Amy Kay, writer and narrative coach, and the producer and editor of the Awakening Doctor podcast. 

 Where do we begin to tell your story?

Prof Hoffie Conradie Guest 04:23

Ja, I’m not sure about that, because I could start way back. I mean I could start from my childhood. 

 Dr Maria Christodoulou Host

 Let’s start there. Let’s go way back. 

Prof Hoffie Conradie Guest 04:36

Ja. So I grew up in Stellenbosch. I'm one of seven children. The last two of us are twins. I've got four older siblings, and then there's a big gap and then three boys. So we kind of grew up in two parts. My father was a minister in Stellenbosch. I grew up in a quite traditional Afrikaans, Dutch-Reformed, very religious family and then went to school at Stellenbosch and varsity and then, you know, from the third year I went to Tygerberg. 

Dr Maria Christodoulou Host 05:09

When did you decide you were going to be a doctor? 

Prof Hoffie Conradie Guest 05:10

There was some unspoken expectation that one of us will become a minister, and so the first two boys didn't. And then I think between me and my brother I kind of thought about that. And then two things happened. In my later years at school, my mother, who was a housewife for most of her life, started working in the local library and she worked some nights till nine o'clock. It wasn't too far from our house but we would walk to the library and walk her back, but we went a bit earlier and then we would help her arrange the books that were returned and put them back. And somehow I saw books around medicine and doctors' experience. Funny enough, also in rural areas, and I started reading more and more about that and thought maybe that's an option, and I was quite excited about that. 

06:11

The other thing that happened is, in Stellenbosch, in the sort of Christian community, there was every year a mission week, “Sending Week”, where missionaries from South Africa and all over Africa came and there were some doctors also. Health professionals talking, and that also kind of, I think, inspired me. And then in matric two things happened. It was the first year that they stopped conscription and everyone had to go to the army. And the second thing that happened is… you always did a BSc first year and then you were selected (for medicine) on your results of the first year, and then they said no, we're going to take 80 students now and you have to apply straight away to medical school. If you do medicine, you can go to the army afterwards. You don't have to go immediately. 

06:53

And so I had to make a decision and, funny enough, my father… we had like a group of boys who came together every Sunday evening and we asked my father one evening to facilitate the discussion and I think, unbeknown to him of my struggle in my decision, he said, sometimes you just have to make a decision and the doors will either close or open. And I said well, let me apply. And that's how I got into medicine.

It was quite daunting for me because there was absolutely no role model for me in our family. There was nobody. I kind of wasn't sure if I will be up to it and be able to do it. So there was always that feeling of, am I going to make it? Especially, I didn't see myself as very handy and I was worried about the surgical stuff. 

Dr Maria Christodoulou Host 07:47

Interesting to hear you say that. I've known you for about 15 years and I know that this idea of imposter syndrome is quite a recurring theme. And yet here you are all these years later, having accomplished so much in medicine. 

Prof Hoffie Conradie Guest 08:03

Ja. Maria, I think the other thing that we talked a bit about that we should bring up now is where I come from as a white Afrikaner. I don't like the word Afrikaner, I don't know. I'd rather say Afrikaans. I grew up in the apartheid era and I realise how privileged I was to get into medical school. Also, I was able to get bursaries and I didn't have any financial to pay off. I stayed with my parents for the first two years. So I think that's just something I want to say up front, that I'm still benefiting from that white privilege in the apartheid years. 

Dr Maria Christodoulou Host 08:44

Were you aware of that at the time? Did it ever occur to you as a young man that you were being privileged in some way, that you could go to medical school or the options that were available to you? 

Prof Hoffie Conradie Guest 08:59

Ja, that's a good question. The other thing, which I'm not quite sure if I answer your question, Maria, is we've also often talked about. There was this ethos of being of service and that, in our house, that you must always be the least. “Jy moet die minste wees”. In a way, the only way I could justify doing medicine was to say that I will go and work - for myself – work in underprivileged areas or under-resourced areas. So that was quite a big theme. And in my second year, one of our friends, one of our fellow students, she died in a car accident, and I remember at her funeral the pastor said, is there anyone that would like to dedicate their life to service? I sort of said, yes, I will do, and I'm not quite sure what influence that played. 

Dr Maria Christodoulou Host 09:56

So I'm listening to you now and I'm thinking I've never asked you this question. It's always been such a given that medicine is a calling for you. You are so passionate about it. And I'm listening now and thinking, so there's this family background of religion and dedication to service and jy moet die minste wees. When you thought about being a doctor, what did you think it was going to be like? What did you think you were going to be doing? 

Prof Hoffie Conradie Guest 10:23

Yeah, that's an interesting question as well, because I, on the one hand, was the service thing. I'm going to work in areas where there are not many doctors and where the under-resourced and poor people live. So money was, in a way, it wasn't spoken about. It's not right to work for money. And I also, always at the back of my mind, I had this idea of being a small town GP where I would see people over a long time. That kind of thing of delivering the babies and then delivering their babies. So that was always a theme for me. 

Amy Kaye Other 11:03

Sounds very romantic.  A romantic image, being the generational doctor. 

Dr Maria Christodoulou Host 11:10

Quite a theme in your life, right? Do you want to say more about that? 

Prof Hoffie Conradie Guest 11:16

Sjoe. I stayed two years at Tygerberg, and then there was… the army also came in-between. It's a long story, but I then started working. My first job was in a rural mission hospital where there was a Dutch doctor who spent his life there. It was his life mission. So I spent three years there and in between did six months of army. Then I moved to another hospital in the then-Ciskei where I worked for three years. So as a student, there was this Christian student organization and during the holidays they had what they called “werker’s kampe” and we would go for two weeks to a mission station and do things there. And I did this during my time, while I was at university, and at Rietvlei Hospital, which is where I ended up starting, but also in a very rural hospital called Bambisana, near Lusikisiki. So that kind of strengthened that. 

12:11

When I was at Rietvlei I met Sam Fehrsen, who later became Professor of Family Medicine at MEDUNSA. He was a real role model for me and he was really the one that inspired me to do family medicine. 

12:30

So after about eight to 10 years of working, I was then living in Queenstown and working outside Queenstown in a place called Harewood District in Whittlesea, and I started doing the family medicine postgraduate course. I kept on working but went up regularly to MEDUNSA and weekends together in the Eastern Cape and the emphasis of that course was so much on the doctor-patient relationship and here I was, virtually the only full-time doctor for 30,000 people. How on earth can you have a doctor-patient relationship if you have so many patients? 

13:07

And that sort of really caused an existential crisis in me and said, shouldn't I rather just go to private practice where I can maybe do that thing of being the GP in a small town? And Sam was a very wise man and he didn't give me answers like you, Maria, he sort of let me brew in it. And I went through an interesting journey, because I really structured my work in that area where there were like 20 clinics that I visited regularly… but with the other doctors, later, that I worked with, we kind of structured the whole system so that there's more continuity of care. So that whole patient-centred care really spoke to me and resonated with me. Ja.

Dr Maria Christodoulou Host 13:57

I think there might be people listening who don't really know what that means. It's a term we use in medical education, but what does continuity of care mean for you? 

Prof Hoffie Conradie Guest 14:06

You see the same patient over time, regardless of the illness they come to or the problem they come to, and in state care it's often, I find, that people don't really see it as necessary, while in private practice it's given, you know? Patients obviously have the choice, but you see the same health provider. If you want to, you see the same one. You can make an appointment. And that's been quite a big theme in my life, that whole continuity of care. So when I left, I spent two years in Canada in a small rural area, a rural village where the road ends, virtually. Where it's minus 30. 

And we were two doctors for 2,000 people and I worked there for two years and at the end of that, I could virtually tell a story about everyone. When I see somebody in the mall or… I knew virtually everyone. And then when I came back, I did go into private practice in very rural places where I was also the government clinic doctor and the hospital doctor. 

Dr Maria Christodoulou Host 15:13

And was that sort of understanding of the importance of continuity of care… Like how did you come to realize that this is what's important? 

Prof Hoffie Conradie Guest 15:24

It's somehow innate, because that's the relationship. For me, the important thing is the relationship with the patient, and that's such a big part of - for me - of being a doctor. More important than making the diagnosis, which is also important. 

Dr Maria Christodoulou Host 15:43

So you go to medical school, you end up working in rural areas, you meet Sam Fehrsen, you study family medicine. Tell us more about how your career evolved from that point, because you've gone on to do some really remarkable things in medical education, underpinned by this belief in the importance of continuity of care. 

Prof Hoffie Conradie Guest 16:12

So I think as part of the family medicine degree that I did… It was a remarkable degree. I think Sam Fersehn was really a pioneer of family medicine. But it was not just about knowledge and skills, it was about the doctor-patient relationship. But also the relationship with the family and then also community-orientated primary care. I think that's also so important and I think in the rural practice I hoped to have that continuity over a long time. But due to various reasons it didn't work out and I moved quite a bit. 

16:44

When I finished at MEDUNSA in 1985, I became a part-time lecturer in the Department of Family Medicine there. So I was involved in postgraduate family medicine education on a part-time basis for many years. In the last three years before I moved to Stellenbosch, at Walter Sisulu University as well. I remember well, the head of the department at Stellenbosch phoning me when I worked in Dordrecht the last… Before I went to Stellenbosch I worked there for five and a half years, and he said to me, are you not interested in a post in family medicine in the Western Cape? And I said no, no, I'm not interested. And a year later he phoned me again and then I thought maybe this is what I really would like to do. 

Dr Maria Christodoulou Host 17:32

Was there talk at that time of teaching being involved, or did the teaching come later? 

Prof Hoffie Conradie Guest 17:36

The post was then in Worcester and it was a place where they sent undergraduate students for short rotations. There was an undergraduate component initially, but then after a year we started a postgraduate training program in that area, which was then Breede River Valley district. 

Dr Maria Christodoulou Host 18:00

You’ve just reminded me that many, many years ago… Fourth year would have been 1987 for me, I spent a month in Worcester at Eben Donges Hospital and delivered babies at the clinics. 

Prof Hoffie Conradie Guest 18:13

Wow, that's amazing. 

Dr Maria Christodoulou Host 18:16

That was quite an experience, I must say. Sjoe Hoffie, I'm listening to you and I feel like there are so many things I want you to talk about, because there's so many things that I know about your life, and then I feel like it's not my place to decide what you tell us.

When you look back on your life story and your career as a clinician and as a teacher and as a rural family physician, what are the things that stand out for you? What are the things you look back on and go, sjoe, that was quite an experience, that was profound. 

Prof Hoffie Conradie Guest 18:49

I knew you were going to ask that question and I thought about it. My gut response was everything, in a way. Ja, because there's so much… It’s a dangerous thing to say, but I don’t have regrets about what I've done and I've really enjoyed what I've done and I would do the same. I mean I've moved quite a lot. I've wondered, because obviously that is against that continuity of care thing. So I've never delivered the babies of babies. 

19:18

That might be my only regret, but otherwise, there were some difficult career decisions to make, but in the whole I think I had an amazing experience. When I was reflecting on that question, I think the highlights on a more individual patient relationship… Home visits. I've always been keen on home visits and love doing home visits. Find excuses to do home visits even now, and so that's maybe the one thing. I think it's Steve Reid that said, you spend an hour doing an appendectomy or less, or a caesarean section, and that's just what you do. But you can get just as much and more information about a patient if you do a home visit. And seeing the patient really in the context where they live is quite amazing. 

Dr Maria Christodoulou Host 20:07

What do you think people miss out on if they don't do home visits? 

Prof Hoffie Conradie Guest 20:11

I'm backtracking a bit, but when I got to Worcester I just thought, somehow I have to have some continuity of care, I have to have a niche where I see patients. 

20:22

In the academic sphere you often just see patients that students present or other doctors ask you for advice. To have your own niche practice in a way. So I started working in an underserved area called Avian Park in Worcester, where I actually started off in a container, meeting up with the community health workers in that area and then seeing patients that they worried about and then doing home visits. And that evolved to a student centre. A student-run clinic, basically, where, when the rural clinical school started, we asked the students... Students had an afternoon a week where they would see patients and we made a special effort for them to see the same patients that year. Usually about three or four visits and then to do a home visit. And what the students always said is, wow, I know the patient so much better, I understand them so much better now. I see now why they wait so long to come to the hospital. You know when we scold them for waiting so long. I now understand what's happening.  

Dr Maria Christodoulou Host 21:23

Ja, it gives you a different level of insight. So, this notion of continuity of care… it's interesting for me that you say that moving around made it harder for you to offer continuity of care in your practice. But at the same time, the other day when we were speaking about this conversation, you had a number of threads or themes that have been continually present in your life, even though there have been quite a few career changes and moves. Do you want to talk about some of those? 

Prof Hoffie Conradie Guest 21:55

The themes that have been relevant to my story? Polarity. From the individual patient through to the community. So I've always been somehow involved in some community projects, you know, often with the community care workers, where it's not just about the individual patient that comes to you now, but what are the needs in the community? What about the patients that don't come to the health service and are out there? That, I think, was quite a theme throughout my life. 

Dr Maria Christodoulou Host 22:28

And maybe linked to that, you spoke about how important Allied Health professionals have been. 

Prof Hoffie Conradie Guest 22:33

I really have a soft spot for... They don't like the word allied, and I'm not always sure, because they're not allied, they're their own. So rehab, but that also includes the dieticians and the social workers and everyone. I've just had, always, a very good experience with them. They were committed people and could contribute so much to the care of patients. Funny enough, in the rural areas, before I came to Stellenbosch, there were very few rehab workers, but in Worcester they were a very good team and we set up an interdisciplinary ward round where we met every week, had a discussion where we all decided together how best we could - and with the patient also, and the family - how best we could manage. 

Dr Maria Christodoulou Host 23:19

So maybe continuity of care is about that interdisciplinary effort to support a patient rather than just the one doctor seeing the same patient over many years. 

Prof Hoffie Conradie Guest 23:30

Yes, and I think that has changed. And that's the reality, that one doctor cannot possibly do justice to a patient. It has to be a team. 

Dr Maria Christodoulou Host 23:40

Let’s go back a little bit. How was medical school for you? 

Prof Hoffie Conradie Guest 23:44

It was very white and very Afrikaans and very male. We had our 50th year reunion last year and there were only four female doctors in the class. 

 Dr Maria Christodoulou Host

 Out of a class of how many?

 Prof Hoffie Conradie Guest

 Well, we started off with 80, and then some dropped off and some added on, and I think it was 73 of us that qualified. 

Dr Maria Christodoulou Host 24:07

Wow. Did you ever question why there were not more women or not more students of colour? 

Prof Hoffie Conradie Guest 24:11

It was such a sort of given in that stage. We had through our then, through the Christian organization, got together with the similar organization in UCT and there were coloured doctors there. So I got to know them quite well and that was really nice for me. In some way, my father was quite a “verligte” man and in the 60s he worked then for the Christian Student Organization, which was an interdenominational organization, and we had black people visiting our house and staying with us, which was quite unusual in that time. So I think I grew up, but still, you know, everything was apartheid. 

24:50

And in my second year I went to this hospital, Rietvlei, to stay with Sam Fehrsen during my December holiday and I took a train from Cape Town to Umtata. It was quite an adventure for me. And then a bus to Kokstad and then hiked to Rietvlei. In that time I didn't do any clinical work, but the doctor said, why don't you work in the laboratory? There was not official, not qualified lab technicians, but people that were trained to draw blood and do the basic blood tests. And there was a black guy there that was sort of the main guy there, and I remember him still, Nceba Ntloko, and we just became very good friends and he taught me how to draw blood and do the basic tests and I still then continued to have a relationship with him when I visited and then worked later there. But that was sort of my first experience of really having a black person that I could relate to and it was quite sad to say that. 

Dr Maria Christodoulou Host 25:52

How is it to be a white Afrikaans man in the world now? 

Prof Hoffie Conradie Guest 26:00

I sometimes wonder about the relevance of a white Afrikaner in South Africa at this stage. 

 Dr Maria Christodoulou Host

 Say more about that.

 Prof Hoffie Conradie Guest

 We're such a small minority in South Africa and I just wonder, is it not time for other people to be the leaders and to be the specialists? Surely it's important… Just seeing how, since I retired, I worked in rural areas... 

Dr Maria Christodoulou Host 26:30

Sorry I'm smiling that you used the word retired, because you still pretty much work full time. 

Prof Hoffie Conradie Guest 26:36

I was forced to retire. I worked at Stellenbosch but then at Walter Sisulu and then later at UKZN, mainly with fifth or sixth year students in their clinical years, doing their rotation in rural district hospitals, and there's been such a change in… When I started working, where there were hardly South African and just about no black South African doctors working in those areas, and now, just seeing the students communicating with patients in their own language, it just makes such a difference. Knowing the culture and not needing a translator, it just makes such a difference. 

Dr Maria Christodoulou Host 27:20

And I imagine for the patients to see doctors that look like them… I know you've had some interesting experiences as a white male professor teaching students in those areas and that sometimes there's been some questions in your mind about the role of the white Afrikaans professor in such settings. Any stories there that stand out for you?

Prof Hoffie Conradie Guest 27:41

On the whole, my experience has been that I've really just enjoyed working with the students and I also made a point of insisting that we go and visit clinics, that they're not just in the hospital. I often had my transport, a rented car or something, because transport is always a challenge and then I’d say, Can we go to a clinic? Can we go…? And I think that was always, for me, very fulfilling. To go out and see… just the patients that are on the bench waiting to be seen. It's amazing. Often those patients that just come to see the Sister, how much one can learn from those patients and the students can experience that. 

28:24

I had one unpleasant experience where I really had to question myself, where a patient was referred to a teaching hospital and the patient came there. I can't remember the detail, but the patient got there a bit late and there was nobody to see them and they had to come back and I was critical of that and said, this patient has gone all the way to the hospital to see the specialist and now just had to return. And I think some of the students saw that as critical of the system and didn't appreciate that? 

Dr Maria Christodoulou Host 28:57

Do you think they made that about race? 

Prof Hoffie Conradie Guest 29:00

I think so, ja. 

Dr Maria Christodoulou Host 29:01

And how was that for you?

Prof Hoffie Conradie Guest

Oh, it was very unpleasant.

Dr Maria Christodoulou Host

I remember us talking about that incident and kind of the grief around, I'm always going to be perceived as the white man, like that's the white Afrikaans man. That's going to be the thing that people focus on about me. And then somehow that overshadows your commitment to continuity of care and the patients that you want to serve and your commitment to excellence in medicine, no matter the setting, because I know rural family medicine has always been a big thing for you. 

Prof Hoffie Conradie Guest 29:35

Ja, I mean, that was one incident and maybe… it did really affect me. It really did affect me. And then there was a lot of appreciation from the students as well for the time I spent with them. I think you touched on something that's a bit on another line. I think that was one of my themes, just where circumstances are often not ideal and then lack of resources also. Human resources, but also others, like medicines and equipment is just to make do with what you have. 

Dr Maria Christodoulou Host 30:11

You also have a lot of stories of doing things like driving around with carloads of medicines to go to different places and distribute them, and being involved in the roll out of antiretroviral drugs for HIV when it was against government policy. Tell us a bit about those things. 

Prof Hoffie Conradie Guest 30:31

Ja. So when I came back from Canada I sort of walked into the HIV epidemic and just saw more and more and more HIV-positive patients. I would never forget one of the first HIV positive patients was a little girl with malnutrition who eventually died, and just that feeling of, we can't do anything. And so so many patients that died. We just didn't have treatment. 

30:58

That was quite hard and I remember hearing from countries up north, Zambia and Zimbabwe, that 50% of the patients in the wards are HIV positive, and that then happened with me as well in those rural hospitals.

What happened was that there was this mother-to-child transmission, when the mother is positive and infects the baby, and there was then nevirapine available, which could prevent that mother-to-child transmission, but it was not available. Dr Hermann Reuter is really the icon of establishing HIV treatment before the government. First working in Khayelitsha and then with Médecins Sans Frontières, MSF, and then in the Eastern Cape. Eve visited me once at that hospital, the last rural hospital I worked in in the Eastern Cape, and nevirapine was actually pretty cheap so I could order it through our private dispensary and then make it available to the babies when they were born, and then it was not government policy. Fortunately, I didn't get into trouble about that. 

Dr Maria Christodoulou Host 32:06

What was it like to be doing things like that? 

Prof Hoffie Conradie Guest 32:10

I think it was just the natural thing to do. I didn't have much... If we could do it, and it could prevent… Really. I mean it's devastating for a child to be HIV positive and have to have treatment for the rest of their life. 

Dr Maria Christodoulou Host 32:28

So how did it come about that you got involved in that? I'm trying to imagine working at a time when your wards are full of HIV positive patients, the government is being quite blind about the implications of this and treatments are becoming available and the government is refusing to make it part of the policy of care… What goes through your mind? How do you deal with that? 

Prof Hoffie Conradie Guest 32:54

I think it was a feeling of helplessness, knowing that there could be treatment. At that stage we didn't know how effective it would be and they were still in the early regimens of HIV, the different regimens. It was really, I think, a kind of feeling of helplessness and when this opportunity came to do something about it, it just felt like the natural thing to do. I've still got pictures of patients that gradually deteriorated and then died. It was hard. 

Dr Maria Christodoulou Host 33:31

You said something to me the other day. It was about students and how hard it is to be a doctor and that you weren't sure that students always know the reality of what it's like to be a doctor and how hard it is, how challenging it is, in some settings. And when I was reading through my notes after we spoke the other day, I was thinking, you're always so positive and so optimistic and so committed to patient care and so passionate about medicine, and yet there is this underlying theme of it's hard. And you've done a lot of work to kind of come to terms with the realities of medicine and to change them through the work you've done in education. I'm wondering about the aspects of it that have been hard for you. What is it that is so hard about medicine? 

Prof Hoffie Conradie Guest 34:22

I think for me the hardest thing is the responsibility for the patient. The fact that we do make mistakes and that it is… in the primary care district health system, you are really the jack of all trades and master of none. Somebody said better than none. It's just that thing that you are responsible for that patient. I've come to realize that how hard we try, and we do make mistakes and then, unfortunately, to the detriment of patients and that sits with us. That's what keeps me awake at night, still. Those things that I know I've made a mistake and that sometimes fatal consequences. There's something also about being a rural generalist family physician, is… You go and do these courses, ACLS and ATLS, where you learn about the emergency care and the doctors in casualties in emergency centres in the big cities they see these patients frequently. So you learn the skill, or you learn the resuscitation algorithm, but you kind of see one or two or three a year and it makes it difficult because suddenly you have to be there. It happens. 

Dr Maria Christodoulou Host 35:39

Are you willing to share any stories of some of the mistakes that keep you awake at night? 

Prof Hoffie Conradie Guest 35:43

Oops, that's quite hard. Maybe that will lead on to another thread. I just want to go back one step. 

35:56

There was quite a seminal experience for me early in my career when a colleague that I worked with, there was a complaint against him and when this was discussed the older doctor asked me to sit in. I don't know why. And the doctor with the complaint against him, the response was a bit of, but I've come here to serve you and this is what you say about me. In Afrikaans we say “stank vir dank”, and that had such an influence on me in that I just felt... Further on, I said, you have a choice to work here. Nobody forces you, and if circumstances are too difficult for you, then leave. But if you stay, then that's your choice. Do with what you have then. And that had quite an influence on me. I must say, I think I've moved... 

37:01

Another long story, but the spiritual journey. In your last interview the doctor so beautifully talked about being the doctor, but also intertwined with spirituality and my journey with that. I'm thinking of Rachel Remen who says fixing and helping doesn't help the patient, often. It’s serving, when we're on equal with the patient. And I think it kind of freed me to be more open in saying I'm not here to convert anyone, I'm not here to to… I'm just here to work and also learn from patients and the community. We're in it together. Ja.

Talking about mistakes, the one situation I thought of was where I was then in private practice and we were two in a small town and my colleague went on leave and he said, do you want a locum? And I said no, I would manage. And I really worked hard and I admitted a patient one day and the next morning he wasn't very much better. 

38:00

And then I went on those clinic trips where you go into the countryside with a bakkie loaded with medicine and stop at the shop or a school or a house and see patients. And I came back very late and I then saw that the patient is not well and the next day I arranged that he goes… I referred him and he eventually died. 

38:21

And that was really, really difficult for me because I had to question myself. Was I overconfident about my ability to work so hard and not take a break? And then should I have referred him earlier? And there are many others, and I think that's the thread also of… There was some - what would you call it, a mindset? A way of being of, I can do this, I can work hard, I can work many night calls and after-hour calls. I manage. And the last 18 months in that small rural town I was the only doctor and really just could only take off when I had a locum.

39:03

I also had this thing of, I can't go away, I have to be there in case there's an emergency, which was also unrealistic, I think. And that just led to me being very burnt out. And the interesting thing is that my receptionist at the hospital, at the surgery, said to me one day, but you're not yourself, you know, and it had to come from somebody else. And then when I got to Stellenbosch I really realized how burnt out I was. And it's that sort of attitude of invincibility. I can work hard, I can take this. It's totally unrealistic. 

Dr Maria Christodoulou Host 39:47

I'm listening to you and I'm thinking about this notion of responsibility and I think I still haven't reconciled in myself the place of that responsibility. You know, on the one hand, you and I are both advocates for equality in patient care and for relationship with the patient, relationship with the students. And then there's this thing of, the reality is you have medical knowledge, you're working in an area where there's no other doctor. If there's a medical emergency and you're not there, but then whose responsibility is it if you're not there? If it's not yours, then whose is it? And in the last couple of weeks I've had… the mother of a very close friend of mine has been diagnosed with an advanced cancer and I was quite clear at the beginning already that I needed to remain kind of on the sideline as a niece, because it's my aunt, but not be making medical decisions. I didn't want to take on that role. But then the oncologist saw her, said that it was just about palliative care now, that a palliative doctor would make contact and sent her home and told her to take Panado when she had pain. The palliative care doctor took more than two weeks to make contact. They were taking Panado in the meantime. 

41:00

I would get phone calls from my cousin late at night saying she's in pain, what can I give her? And then I noticed my own anxiety about being the one to prescribe morphine, and I didn't want to do it. There was such an anxiety. I knew that's what needed to happen. I knew that was the protocol. 

41:18

I know about palliative care. If it was someone else, I may have done that quite easily, but there was something about this person being close to me and the responsibility of, what if I'm making the wrong decision. I don't have all the medical information at my disposal. What if I give her too much morphine? And so, I mean I helped them get access to a carer and to a palliative doctor and a nurse and got involved in making all of those decisions, and then found myself feeling incredibly relieved when all the decisions they made were the things I would have recommended. My cousin would say to me, it's exactly what you said. They've given her the patch you said that we needed to get. So it's this interesting thing of I do know, but I don't want that responsibility and I don't know how to hold that responsibility, and I think it is the thing that creates such a lot of burnout. 

Prof Hoffie Conradie Guest 42:09

Absolutely agree with you. I think that is a big part of the burnout, is that responsibility. And also thinking that we should fix and help and if we can't, then we're very, very uncomfortable with that. I think that's the other side of the polarity of continuity of care. You know, if there's no continuity of care, you don't know what has happened to that patient. You don't know if the treatment that you prescribed worked or if the diagnosis that you made was the right diagnosis. 

42:40

Now that you have a relationship and continuity, you’re the guy. You have to… or the woman… you have to… You could refer and consult, but you're still the responsible person and that, to me, is a heavy burden. I see it again now. I mean, I sort of had this illusion that I could work eight to five, but medicine is not an eight to five job. You always have those patients at the back of your mind and say, did I do the right thing? What about the results? I followed up on the results. Should I do something else? Did I make a mistake? 

43:16

And now that I work one day a week at the local clinic in the town where I live, in a small coastal town, I just work from 8 to 5, 8 to 4, in fact. But I'm much more busy with the patients, you know. With referrals and following up results and sometimes getting WhatsApp messages or calls, and it just sits with you. And that's maybe to come to the other thread of the interconnection or the intertwinement of you as a person and you as a doctor and a professional healthcare worker, and I think that was quite a journey for me.

Dr Maria Christodoulou Host

Say more about that.

Prof Hoffie Conradie Guest

It started sort of in my early 30s. I think I was still quite steeped in the traditional Christian religion and belief and then I had a personal - I wouldn't even call it a crisis, it was just an ongoing challenge in my marriage - that really was extremely difficult for me and I then started psychotherapy and, as you know, I'm still, 40 years later, I'm still having regular sessions with the psychotherapist. So that’s continuity of care for you.  

Dr Maria Christodoulou Host 44:40

And I love that you've maintained that relationship because the little bit that I know of that relationship, for you there's been such a deepening of the connection and the self-awareness that's come from that and the rich discovery that it has enabled.

Prof Hoffie Conradie Guest 44:59

Ja, and it is exactly what you say, the self-awareness. I think at that point I wasn't a very self-aware person and not very aware of… I mean, I had lots of strong emotions but not very aware of that. Able to be with that and not to be critical of myself for those… sadness and frustration and anger. 

Dr Maria Christodoulou Host 45:23

One of the things you've spoken about quite a bit is the influence of religion and growing up in this Afrikaans home with a father who was a Dutch Reformed minister, and the thing about being humble and being of service, and I know that your beliefs about some of that have shifted and changed over the years. So say a little bit about religion and how that influenced your career and how your thinking about that has changed. 

Prof Hoffie Conradie Guest 45:50

Just to say, Maria, that it's not easy for me to talk about that because it is a very personal journey, and it's been a long evolving journey. With the psychotherapy, what really became clear with me is that, over years I would say, that I'm responsible for my own life and for my own decisions. 

46:14

That was difficult for me because “jy moet die minste wees”. You're not allowed to have your own needs up front. You have to serve other people. It was a very difficult decision for me and it took me many years to come to the point where I had to make a decision for myself that could be not good for other people and for my children. I became disillusioned in the traditional Christian religion. 

46:54

It started, funny enough, a bit earlier when I was in Queenstown. It was really that time of the political activism and I was involved in the local sort of organizations, but I just couldn't go to the NG-Kerk anymore because of the whites only. And I went to what was called then the “Sending Kerk” and joined that. But then I became even more disillusioned with religion and didn't go to church for a long time. I think maybe it's so much to say about that, but it just helped me to become really aware of my own feelings and my own emotions and in a way take responsibility for myself. It was such a theme in the previous part of my life of, you have to do God's will, and I kind of came to a place where I could say but maybe my will and God's will could align, you know. 

Dr Maria Christodoulou Host 48:03

So would you say that your work today or your life has been about doing God's will?

Prof Hoffie Conradie Guest

Oh, that's a deep question, Maria. I think, where I am now, and like Rachel Remen talks about her grandfather, who was a Jewish rabbi, who talked about the origin of the earth, where God was light, and then this light shattered and each one of us have a little bit of that light, a little bit of God in ourselves and that… I really resonate to that. So I've come to the place where we really live… 

48:39

There's so many cliches Maria about your real self or your true self, but if you really live in alignment with your inner core, with your inner self, that is God's will, because that's part of God in you. This is where I am now, at the moment. That’s a lifelong work.

Dr Maria Christodoulou Host 48:58

I love that and that reminds me of your coaching models. What we haven't talked about is your journey with coaching and actually how you and I met. I was remembering the other day… I'd completely forgotten that when I first started at Tygerberg in 2009 or 10, Bob invited me to participate in the WONCA conference and I did a little breakaway session about health coaching, which was very new and not known in South Africa at the time. 

49:27

There was nobody really talking about it and there were a lot of people in the room, but you were the only one who really took a keen interest in this possibility of a relationship of equals being transformative for people, and I think you were quite forward-thinking in your ability to see how this might have application in medical education or in doctor-patient relationships and I was very, both intimidated and humbled, when you asked if I would coach you. There you were, Professor Conradie, founder of the Rural Clinical School, and you were asking me to coach you, and it's been such an amazing privilege to witness you grow and transform and adopt a lot of the things that coaching embodied. Go on to qualify as a coach yourself, now using coaching skills to coach and mentor colleagues. What has that been like for you? 

Prof Hoffie Conradie Guest 50:20

That was an amazing journey, Maria. The university offered to us a 360 assessment.

Dr Maria Christodoulou Host

That’s right. A leadership assessment.

Prof Hoffie Conradie Guest

And then I think we had one session with a coach as part of the deal, but I was… quite an eye opener for me that assessment, that 360 assessment. It was very clear that people were honest in their feedback. That there were the good parts of me, the things that I do well, but there was definitely a shadow part there that I had to work on and I just felt that I would like to work more on that, and that's when I approached you. That's when it started. 

51:03

At that stage, time management was a big thing. I got into terrible trouble because I had 200 unanswered emails and I'm not an office man. My secretary in Worcester said she had to make an appointment to see me. I wasn't fond of sitting in the office and I had this illusion that I just have to manage my time better. And one of the first things you said to me was, what are your values in life, what are your priorities? And I think that was quite important for me. To realize it's not about time management, it’s about what do you really want to do and what is the important stuff that we tend to neglect. 

Dr Maria Christodoulou Host 51:44

One of the metaphors we've often used is, you talk about the backpack and the amount of things that you have in your backpack, and often you're measuring your own efficacy by how many things in the backpack have been taken care of. 

51:56

But I think what's interesting is that what I remember about those conversations about time management, is that once we spoke about values and what was important to you, almost everything that aligned deeply with your values was being prioritized in your life. 

52:11

Everything you were doing was aligned with your values, and the things that were being neglected were not really of that much importance to you personally, even though they may have had importance to others or to the system, or to academia, or you know, whatever it may be. So the one thing that actually stands out for me as I sit here now is… there's this assumption in medicine that the career path is you become a GP, then you become a specialist, then, if you stay in academic circles, you must go on to do a PhD. And you've chosen not to do a PhD. And yet here you are, an Emeritus Associate Professor of Family Medicine and founder of the Rural Clinical School, and you've done a lot of really innovative things in your career. So what would you say to somebody who wanted to know whether they should do a PhD, whether they need a PhD to influence medicine? 

Prof Hoffie Conradie Guest 53:04

It's not that I didn't have the aspiration to do a PhD. I just never got the time to do it. And it was, as you say Maria, because there were just other things at that time that just, for me, was more important. I had all sorts of ideas of doing a PhD. Attended workshops and courses and things, and I just never got around to do it because there was always, especially around the Rural Clinical School, there was just so much to do. And just to say that I've got so much respect for my colleagues who, in spite of all their busyness, did do a PhD and got that qualification. You know, Maria, I don't like to give advice. 

Dr Maria Christodoulou Host 53:42

Please give some advice A younger colleague who's thinking that they need a PhD to make a difference. 

Prof Hoffie Conradie Guest 53:50

There's that word, Maria.

Dr Maria Christodoulou Host 53:53

I know. As I said it, I realized. People don't know this about Hoffie, but a few years ago we sat in a workshop and somebody commented on just how much of a difference you had made in your life, and this was offensive to you. You didn't want to think of yourself as someone who had made a difference and you felt you don't make a difference. 

Prof Hoffie Conradie Guest 54:12

Make a contribution or add value was the word I think we decided on. I think the reality is that if you really want to go now into an academic career, you will need a PhD. That's the reality. The other thing that I would say and that's also the advice I give to undergraduate or registrars in family medicine in their research, do something that you're passionate about. Do something that's part of your work, that's not outside of your daily routine and work that you have to spend a lot of time outside of your work, and obviously, it's a much easier said than done and there will be a huge effort outside of your work still, but if it's something that you're really passionate about, that makes it easier, because research is an up and down journey. 

Dr Maria Christodoulou Host 55:02

And I mean you have published extensively, so let's put that out there. And I will admit that when I was thinking about doing a PhD and I look back on that journey now and… I stepped away from it, I decided not to do it, and you were one of the role models that made me realize that the part of me that wanted a PhD was the imposter syndrome. It was this thing of, if I have a PhD, then maybe I will have influence, then maybe people will take my ideas more seriously. And on one level I know that that is true. People do take your ideas more seriously if you've got a PhD behind your name. But I saw just how much of a difference you had made without a PhD and I realized that there was no part of me that had a burning question about something to do with professional practice. 

55:49

So when you talk about somebody choosing a PhD subject because it's something that's part of their day-to-day work and something they're really interested in or passionate about, I was coming at this idea of a PhD from the place of, I have to find something to do a PhD on so that people will take me seriously on these other things that I'm interested in, and that was the wrong... I'm really glad I didn't do it, because I think it would have ended up in me being severely burnt out and coming to the end of the journey and realizing that the work of being taken seriously only begins once you're done with a PhD and then you have to start presenting and going to conferences and writing papers. So I've come to terms with maybe one day I will still do a PhD, because there's something I'm really passionate about investigating further. Be really clear that this is something that you want, not something that you think will legitimize your knowledge. 

Prof Hoffie Conradie Guest 56:43

Or for career progression. In a way, I don't regard myself as an academic. I was quite comfortable being in Worcester and not being at Tygerberg campus and really being, just really involved in the day-to-day clinical work. And you also know that I don't like the word teaching. Maybe I should explain that. I think I associate teaching with giving information and I think there's so much more to education than giving information. Surely, that's part of it. Surely you have to acquire knowledge and skills, and that's more, I think, applicable to the later clinical years. Most of the students that I’ve really worked with, fifth and the sixth year medical students, it's about… I call it facilitating learning. It’s to help them to find the information and the resources and then apply it to the patients that they see daily and decide whether it's relevant or not. 

57:49

And I mean, in that way there could also be creation of new knowledge. The other thing that I so strongly feel about, is that we learn around the patients we see. Rather than going to sit at night and open the book and decide I'm going to study this chapter on diabetes, rather say I've seen Mrs Zulu today, she's got diabetes, I've had some questions around maybe the diagnosis or the management, and I go to my resources with her in mind. 

58:18

And I read and I look for answers, because that's so different from just memorizing a lot of information. Ideally, going back to that patient and saying, oh, I read about this, what about this, can I do this? And that to me also, hopefully, is not just then about passing the exam, which is necessary. Creating that lifelong habit of learning. And that's how I learn at the moment, around the patients. Often the patients I see, I will go and… while I'm in the surgery still, or at home at night, go and look up about the patients I've seen. 

Dr Maria Christodoulou Host 59:01

I think that's also something that people don't always understand about medicine. There's this assumption that once you've learned the material, then you know it and then you apply it. And yet, firstly, the material is constantly changing. There's new knowledge coming out all the time, so it's quite hard to stay on top of that. And then the application of that knowledge in each context or with each patient is completely different. 

Prof Hoffie Conradie Guest 59:24

I remember one of my student colleagues when he did his internship and the professor asked him a question, he looked at him and he said, “nee Papa, my papiere is in die kas”. My papers are in the cupboard, I don't have to learn anymore. And it's so different. We have to... It's a continuous learning journey. 

Dr Maria Christodoulou Host 59:45

You've talked about how you see teaching and learning and the role of the facilitator of learning rather than the teacher. Your perspective on students, because I think you have quite an interesting way of thinking about students and what your role is in the relationship with them?

Prof Hoffie Conradie Guest

I’m scared of using cliches, but I think the one from where I engage with students is really to see the uniqueness in every student and to use that word, be student-centred. Build a relationship with the students like we do with the patients.

And we often have the opportunity, especially in the Rural Clinical School, where we have students for a whole year, the opportunity really to develop relationships with the students. But even places where I had shorter interactions with students, I really valued having an individual interview with each student and just sit down with them and say, tell me about yourself. And that to me is amazing, how that changes my relationship with the student, because I ask them just tell me where did you grow up, tell me about your family and I love drawing genograms for my students and my patients and just say what happened at school, how did you get into medicine, how do you feel about it now, what are your aspirations for the future? And also what outside of medicine? What is your interest, what are your hobbies, what makes you tick? And I just always felt after that interview I just have a different relationship with that student. 

01:01:19

I think the other thing for me is to really create an environment of a safe place, if I can call it that, where students are comfortable learning, because you don't learn well when you're fearful. Where they can ask questions. And so often students are belittled and fearful of asking questions, or rather standing at the back and being invisible.

And that's what happens in the rural areas and the Rural Clinical School where there are fewer students per teacher/ consultant, where it’s much more a hands-on individual experience, and so I think that… creating that atmosphere of being part of the team, not just a hang-on student. And that’s often the experience the students have in the rural settings. That they feel they can become part of the team, they become useful and the doctors also find them not a burden but useful after a time, or part of the team, contributing to the team. 

Dr Maria Christodoulou Host 01:02:23

The theme of continuity. I mean it's an ongoing one in all your stories. What I'd like to also maybe highlight about the rural clinical school is that you had this vision of being able to offer not only continuity of care to patients but continuity of learning to the students, and that you pioneered the first medical school curriculum that was done entirely in a rural district rather than in an academic hospital in an urban area. And I think you started that what 2011, with a small group of students that then went right through all their six years of medical school in Worcester. 

Prof Hoffie Conradie Guest 01:03:03

No, just the final year. The model is that some of them did visit Worcester before, but this was the first time that students could do their final year, the whole of their final year, outside of Tygerberg. We started with eight students, six at Worcester, which is a more traditional model because they rotated through different departments. But then the real innovation was two students who spent their whole year in a district hospital in Ceres. That was quite a thing, because there were no specialists in that district hospital. No, there was a qualified family physician there. And that model still goes on, where some – not many, but some students spend their whole year in a district hospital. But even at Worcester Hospital, it's very different from being at Tygerberg.

Dr Maria Christodoulou Host 01:03:48

So Hoffie, should we talk a little bit about what it's been like to retire and not retire, as I said earlier. But what was it like to get to that point where retirement was imminent and that that meant you would have to step away from work that you were actually really passionate about? 

Prof Hoffie Conradie Guest 01:04:04

I was one of those people who didn't want to retire. I really enjoyed what I was doing and I had that continuity of care at Avian Park where I still have contact with some of those people there, and so I was one of those reluctant retirees and when I reached retirement age the university then employed me for another year until they appointed somebody else. It was actually in that final year that I did the coaching diploma and then the university… Very grateful that they were positive about me doing that and allowed me the time. And then I actually already started working in the Eastern Cape on a Stellenbosch project where I was involved with students in rural district hospitals. 

01:04:49

Walter Sisulu was then the first university where students spent, in their fifth year, and still now a whole semester, 20 weeks, in a rural district hospital. So it's not the whole year like Stellenbosch, but it's the whole class. In Stellenbosch it was just a small percentage of the students. So I became quite involved in that development. What they call the longitudinal integrated clerkship. So it was like a smooth transition for me and I didn't continue at Worcester and it was difficult for me, but I think it was the right thing. It was just a part of my journey that had to come to an end and then continue with something in other parts of the country that was similar to that. 

Dr Maria Christodoulou Host 01:05:34

So maybe say a bit more about what you actually are busy with now, at this stage of your career. You retired how many years ago? 

Prof Hoffie Conradie Guest 01:05:41

I think it's seven, something like that. I've always been a small town man. You know, I grew up at Stellenbososch, which was not so big as it is now and I always felt more comfortable in small places, so kind of worked in the district hospitals in the Eastern Cape with mission and district hospitals that were small areas and often lived on the hospital grounds. But then in Canada, it was a small place, and then I worked in Bonnievale in the Western Cape for two years. It was small, and then two small towns down in Queenstown and then I moved to Worcester and I’ve lived there for 14 years I think, and I really enjoyed it, but it was a bit too big for me and then I retired. I moved to Kleinmond, which is a small coastal town about 100 kilometres from Cape Town, and I had a deep connection with Kleinmond, because my parents… As a minister my father lived in the house provided for the minister and so they got this holiday cottage in Kleinmond and we would always spend six weeks of our summer holiday there. So it's really so part of me, and after, with my children, we always spent time in Kleinmond and it's like my Ikhaya. It wasn't my birthplace but it felt like that, and so when I retired it wasn't a difficult decision. I bought a house which is very close to the family house which is still in our family. When the contracts came to an end for my work in Eastern Cape and KwaZulu-Natal… 

01:07:12

My clinical work at that stage was mainly through students. So that's what I really enjoy. People always ask me, you're a professor, do you lecture? I don't like lecturing, because that's teaching, and I like just being with students while they're seeing patients, and that's what I really enjoy. So then I had to decide should I hang up my stethoscope? And then I approached the nearest district hospital and they eventually said but I can work at the local clinic. 

Prof Hoffie Conradie Guest 01:07:44

And now I work one day a week at the local government clinic in the town where I live and it's, for me, all the principles of family medicine. You know, you live in the community where your patients are and you're part of the community and you see them outside of the consultation room. I don't see patients primarily. It's patients referred by the three nurse practitioners at the clinic that refer patients to me if they feel it's necessary, and I have time with patients. We talked a lot about that, Maria, but I just feel I actually spend about half an hour per patient because they’re booked for me for that day when I visit the clinic and I really enjoy that. I struggle still a bit with continuity, but I can organize my work so that there is a fair amount of continuity. Now, I've been working there for about 18 months and probably about three quarters of the patients I don't see for the first time, but the other things I'm involved in… 

01:08:41

So I started in 2019 working in Zimbabwe where they started a postgraduate family medicine training. The first one in the country. So I've been involved there since then up till now and that has been quite a journey and an interesting journey. So that is postgraduate and then I'm part of a mentoring program for medical students at Stellenbosch University. It was Prof Julia Blitz's brainchild. But the idea is that there is a student mentorship program and then there's sort of an academic mentorship program, also students, and then there's the professional student services, psychological services, and the idea was to have something in between and not necessarily for students that struggle, but students who want to have a mentor-mentee relationship with a qualified doctor. So I'm involved with that, I'm sort of organizing that. It's a very small scale but slowly it's picking up and it links a student with a doctor and they meet when it's convenient for them and have a kitchen table discussion, right. 

Dr Maria Christodoulou Host 01:09:54

Right. So you're actually mentoring the mentors on that. 

Prof Hoffie Conradie Guest 01:09:57

Ja.

Dr Maria Christodoulou Host 01:09:58

Tell us about your Taking Care program, because I think that that's such a valuable program for our colleagues. 

Prof Hoffie Conradie Guest 01:10:04

I just want to say about the Academy of Family Practice. They also started a Next5 program where they support newly qualified family physicians in their first five years of qualifying, and there are quite a number of aspects. One aspect is a mentoring program, and so I'm also the sort of organizer of that. I also have my own student mentee, so that's also been really a journey for me. It's not taking off wildly, but it's an ongoing program that we develop. The Taking Care… this thing of caring for yourself. I told you about… Maria, now I'm going to “loop lang draaie” as we say in Afrikaans. 

01:10:48

I think my burnout was because I didn't care for myself. I had this illusion that I could just go on working and working, be on call every night and every weekend. I think what I realized is… slowly, over time, that I need to care for myself. I think I always cared for myself through physical exercise and being in nature. That was always a very important part for me. I think that sort of kept me going and prevented me from really serious, more serious burnout. Mountain biking and running and hiking and playing squash, and then my love for nature, bird watching, and now I'm into the fynbos as well, in Kleinmond. So that's a thread that was really important for me. 

01:11:42

And there’s always something special for me about being physically active. I am a bit competitive as well, but pushing myself. So that was a way in which I cared for myself but, you know, when you're really physically exhausted, it also becomes difficult to keep that up. On the other hand, maybe even causing more physical exhaustion. I realized that one of the insights that… I always say “’n liggie wat vir my opgaan” is that as you need physical exercise and training, so you also need mental training, and I think that started with the psychotherapy. Becoming aware of my own feelings and working through all the issues in my life that started as a child and being aware of that. 

01:12:29

And then the coaching. And I think that the coaching, in a way, is also that thing, Maria, of what are the options, what is happening? You know, what does it mean to me? But what are the options? And talking through the options and I think that's what you're good at, Maria, is challenging me to think about other options and other ways of looking at… and what I appreciate about the coaching. But then I had this thing of should I meditate or not? And I tried meditation and I just thought, no, my mind just goes off in a hundred different directions. I'm not one for meditating. Then I read a book by Dan Siegel called Mindsight, in which he very eloquently explained this thing of you have to practice. It doesn't come naturally. And then my partner, Eve, and I started using an app and started meditating with guided meditation, and that was a way of really… different way of caring for myself. 

01:13:30

And Maria, this thing that Brene Brown says that the most compassionate people are also the most boundaried people. That was difficult for me because I thought I was compassionate but I don't think I'm very boundaried, and that's why I often end up being burnt out. So Taking Care was then an initiative from the four of us. Janine Kirby, she's a general practitioner in East London and she's an integrative practitioner and she's now the chairperson of the Institute for Mindfulness in South Africa and she's been running the MBSR - the Mindfulness-Based Stress Reduction courses - for many years with a colleague in East London. With her and two other colleagues, Pete Milligan, who's a psychiatrist in Ngwelezana, and Belinda McIntosh, who's working in Limpopo, and who is also a mindfulness-trained teacher, we decided to start an eight-week online course for healthcare practitioners in mindfulness-based stress reduction, but managing stress and preventing burnout. So we run about two courses every year, and an on-site workshop at the last rural conference as well. 

Dr Maria Christodoulou Host 01:14:45

We'll put a link to that program at the bottom of the podcast description so if people are interested they can find out more. There was something you said a moment ago about the mentoring and how there's not a lot of people coming to the mentoring program. It's still quite small. What do you think it is that causes people to be hesitant to sign up for coaching or mentoring? 

Prof Hoffie Conradie Guest 01:15:11

Hmm. I wish I knew, Maria. It's that experience of what I had myself, just thinking I can go on and on and on and I must just cope and I must just sit, take what is happening, and I think a lot of doctors have changed and have a different attitude now. 

01:15:26

But it's in a way, I think, difficult. In some way it's maybe saying I'm not coping and sort of admitting that. It's also… Every now and then I hear a medical student or a doctor say they, as a student, they were really emotionally affected by something that happened with a patient and then they would start crying, being sad, and then were just told afterwards, that's not right, you can't do that. That's not professional, just keep in your emotions. And I think that's what's so important that we really, on the one hand, when we have empathy with a patient, we put ourselves in their shoes and we want to tune into our patient's emotions and their needs, but we also need to tune into our own emotions and our needs, and that's, I think, what often not happens. I just hope that the mentoring and the coaching and the Taking Care course brings that aspect, which needs practice, is actually being aware of what is happening here in yourself. 

Amy Kaye Other 01:16:38

Why I think people don't take up coaching or mentoring as a coach myself, people want a quick fix and coaching and mentoring is a long process and you have to be willing to do the work, and most people don’t want to do the work. They want the answer now. That’s what we've all been taught now. Like everything must be instant. You can just go on Instagram and get some pop psychology and a lot of people don't want to do that deep self-reflection and don't want to look at their shadows and don't want to look at the areas where they need work. And I think mentoring and coaching or therapy or anything like that is scary for a lot of people, because what are they going to find when they start asking those questions or get asked those questions? So people want it, but it's that fear of how do you take that leap? 

Prof Hoffie Conradie Guest 01:17:23

Is it not the vulnerability then? The fear of becoming vulnerable? Yeah, absolutely. 

Dr Maria Christodoulou Host 01:17:32

So I went last night and, just as part of preparing for today, I looked at the Taking Care website and you've got that beautiful quote by Rachel Naomi Remen. I'm not going to remember the exact words so help me out here but it’s something about, you can't bear witness to suffering and not be affected. It's like imagining you can walk through water without getting wet.

Prof Hoffie Conradie Guest

 Getting wet. Exactly.

 Dr Maria Christodoulou Host

And I think, even just as part of our training, the nature of our work is that we get to bear witness to people's suffering and it's naive actually to imagine that we can do that and not be affected in some way. And one of the things that I don't think is encouraged enough in our profession, or certainly not when you and I were being trained, is the idea that we should have some kind of supervision, some kind of mentoring, to process that and to take care of ourselves in that. And so I love that at this stage of your career, that's what you're doing. You're offering that space through the coaching, through the mentoring, through the Taking Care program. 

01:18:28

I think it's really, really important and even for me, even reading that quote last night. There’s been a lot happening in my personal life and then there's been a lot… I've been getting quite busy at work. A lot of people dealing with really serious things and then wondering why I'm finding it hard to access joy sometimes, and why I'm not so playful. Well, that's exactly why. And I am in therapy and I do do things to help me, but there's still that thing of when you're immersed on a day-to-day basis in the difficulties or the challenges of life, you have to remember that it affects you too. And that, to any colleagues out there or people out there who are a bit scared of the vulnerability of a coaching space or a therapy space, that actually you become a better version of yourself if you have some way to debrief about those things and to explore the impact on you and to kind of come back to your own centre with regards to those experiences. 

Amy Kaye Other 01:19:20

All these different South Africans and all the kinds of jobs that we have in this country. Not that we are particularly different to anywhere else, but I think, just as a South African, the stuff that we have to deal with on a daily basis in terms of the suffering that we see. Just being in your car and seeing all the homeless people that need help. Violence in terms of GBV, in terms of all the stuff that we deal with on a daily basis as South Africans, we all need support, and there are so few places in terms of the work environment where you get offered that, and especially when I think of people that are helpers, whether you're working in medicine, or whether you're in police or working as a teacher, whatever you're working as, you don't get that support. So then having to go out of yourself to go try and find coaching or try and find therapy, it's quite a lot because it's not normalized and there's hardly ever any budget for it. South Africa needs a lot of healing.

Dr Maria Christodoulou Host 01:20:19

Well, even when there is a budget, they don't really sign up. 

Prof Hoffie Conradie Guest 01:20:23

I was intrigued by your last doctor that you interviewed that said that in the USA you get CPD points. 

Dr Maria Christodoulou Host 01:20:32

How amazing would that be. Ja. So Hoffie, you touched on your physical activity and how much you like spending time in nature and it kind of feels like you didn't quite do it justice, because I wrote down the other day, you have done 28 Cape Argus cycle tours and a whole lot of other trails and running and triathlons. Tell us a little bit more about your sport and life outside of medicine. 

Prof Hoffie Conradie Guest 01:20:56

The three brothers, the second half, my older brother was really a brilliant academic and I sort of found my expression in sport. I just love playing sport. When we played a rugby game I was sort of disappointed where the ‘fluitjie’ was blown for the end of the game. My mother was also part of this. She loved nature and when we were here in Kleinmond she knew the flowers and she would take us for walks and we would swim in the river and go down to the beach and it was just an absolute part of me from an early stage. 

01:21:32

And I was in Stellenbosch today and I passed a cycle shop and when I was, I think, 12 or 13 years old, at that shop… Probably many owners since then, but we had some holiday work and we each bought ourselves a Raleigh three-speed bike for R40 and we just cycled with those bikes and did tours. Part of our afternoon exercise was to go up Jonkershoek or Helshoogte with our bicycles. At varsity also. So it was always part of my life. And then I had a short running career but then I was mainly into cycling. When I came back from Canada I started mountain biking. It's like the trail running of cycling. Stay away from the tar roads and cars and just cycle on single tracks and jeep tracks. 

01:22:22

You're in touch with nature then, and the birds and the flowers, and I've done quite a number of cycle tours, cycling with friends, with Steve Reid and other friends. We go regularly and just find a place, a route, and cycle, and I just love being out in nature and also in the Eastern Cape and the Wild Coast. I did so many over weekends cycle trips there and you're kind of in touch with the people in a different way than when you pass in a car. They shout at you and you connect with them. 

Dr Maria Christodoulou Host 01:22:51

Do you still take your bike with you when you go on visits to those rural districts to teach?

Prof Hoffie Conradie Guest

Ja. 

Dr Maria Christodoulou Host

Amazing. So let's talk about your children. You have quite a big family. 

Prof Hoffie Conradie Guest 01:23:09

Ja, so I've got five children. The eldest two are doctors and then twin boys. I've continued the tradition with that. He’s in IT, and the younger boy, that’s the youngest, Hoffie, I think it's now called people management, not human resources. Except for Henry, the oldest one, they’re in Cape Town, but we get together very regularly and that's wonderful for me. Absolutely amazing. And now the grandchildren, it's just wonderful. I often said to you, Maria, just… Obviously as a grandparent, it's not 24-7. You have them for a more limited time, but just spending time with the children and they teach me mindfulness, Maria, because they’re just in the moment. They don't have an agenda or something to achieve. They’re just…whatever they see that interests them, they’re there, and I love just following them. Not interfering with…

Dr Maria Christodoulou Host 01:23:59

I have an image in my mind of a story you told me with your first grandchild and she must have been maybe two or three and you’d been doing exactly that, following her around in the garden and just watching everything that she looked at and touched, and I remember you coming back and going. I now finally understand what mindfulness is. This ability to just be totally present with whatever you are doing and be fascinated by everything. 

Prof Hoffie Conradie Guest 01:24:29

So I have six grandchildren and Eve has got two. My partner has got two grandchildren. So ranging from, I think, nine months to nine years. It's quite a chaos when they're all together, but they love coming to Kleinmond and it's just such a privilege for me to have them there. And my siblings, out of the seven, four are still alive from the first lot. One sister is alive and she's now turning 90 soon. But we've always been a close family and get-together regularly. So that's an amazing part of my life is always having that extended family. 

Dr Maria Christodoulou Host 01:25:09

That continuity.

Prof Hoffie Conradie Guest

That continuity, and with my nieces and nephews, I just love it. We had a family reunion in December in Kleinmond and we were nearly 50 people together. 

Dr Maria Christodoulou Host 01:25:22

That's amazing. So what advice would you have for a young colleague or a young student, a scholar, who's thinking about medicine as a career? 

Prof Hoffie Conradie Guest 01:25:31

But, Maria, you know I can't give advice. 

Dr Maria Christodoulou Host 01:25:33

I know. You can. You can share of your experience. How's that? 

Amy Kaye Other 01:25:39

What’s that about? Why can't you give advice? There's a story there. 

Prof Hoffie Conradie Guest 01:25:42

There's a quote in my diary that says we shine the light so that other people can walk. So I kind of… Amy, it’s a thing that I think people… In coaching as well. It's about helping people, facilitating that process of people finding what is right for them to do and that's not me, I can't say that, but it's helping and facilitating that process. You don't ask people what to do. 

Dr Maria Christodoulou Host 01:26:08

You don’t like telling people what to do. Let's put it that way. Advice can be given and people don't have to take the advice. So maybe you can make some recommendations for a young person who's thinking about going to do medicine or medical school. 

Prof Hoffie Conradie Guest 01:26:21

I think the one thing I want to say up front is that it was an unusual decision, as I've explained, for me to do, but I haven't ever had doubts about that. I think so many medical students I find, do have doubts. So I often had the doubts of will I be good enough? There's some stories I can tell you about that as well. But then when you make mistakes you question yourself. But I've never had a regret of becoming a doctor and it's a long journey. As you know, I really still love the Wednesday at the clinic. I just feel very fulfilled by it. 

Dr Maria Christodoulou Host 01:26:58

So what would you say to a colleague in retirement reluctantly? You're now six, seven years beyond that point, and maybe there's somebody sitting at Tygerberg now or at UCT and approaching their 65th birthday and really not wanting to retire because they love what they do. What would you say to that? 

Prof Hoffie Conradie Guest 01:27:17

Maybe just to come back to the students, if I can just follow that through. I think it's that polarity and, Maria, you know, I like this interdependent pairs of polarities where there's a spectrum between the two ends and it's not right or wrong. What I like is we move up and down between those polarities. Sometimes it's better to be more on this side than that side. So just to say that my fulfilment and enjoyment of medicine hasn't been so much to make a wonderful, new, unusual diagnosis or give the right treatment. I mean, all those things are important. Or do a procedure. It's amazing to do your first caesar and then you'll get to become more and more proficient and then it becomes more routine. And so often part of medicine is like doctors say, oh, I just sit in this chronic clinic and I just see the same chronic patients and prescribe the same medicine. But for me it's that person. Unique, individual person that have that unique experience of their disease. That is for me the fulfilment in medicine. 

01:28:23

But then the other side is the responsibility, accountability. Such a cliche and… I don't work in emergency at all, but you really… Sometimes the life and death thing, not in that emergency, but what you do with the patient and what you miss. And that is a heavy responsibility that's always there and I'm not always sure if students, you know, when they get to their internship and they have to work so many hours overtime and they get tired and then burnt out or disillusioned and become… That depersonalization then of burnout, where you find it difficult to see that patient as a person and not just another burden that is coming to you. It's a wonderful profession to be in but it's not easy. It's a huge responsibility. 

Dr Maria Christodoulou Host 01:29:22

I would agree. 

Prof Hoffie Conradie Guest

So you asked about retirement…

Dr Maria Christodoulou Host

Mmm. What advice would you give a colleague who's approaching retirement? 

Prof Hoffie Conradie Guest 01:29:26

I'm going to repeat advice that was given to me, which I think is really very true and important and real, and that I not always find it so easy. Do what you really like, do what is your passion, and don't do something because you think you should do it or to keep busy. Be selective about what you take on. We've had discussions, Maria, about my backpack that doesn't want to become lighter, and you've challenged me on that as well. And then I think, do what gives you energy. That makes the glass full, so that you can give from what is overflowing, and not empty the glass as what happens when you get burned out. 

Dr Maria Christodoulou Host 01:30:13

I think what stood out for me over the years as I observed you navigate this journey of retirement and I say that with inverted commas because you are still working full time. You do one day at the clinic, but your days are full with all sorts of other things and the teaching and Zimbabwe and Namibia, and you're still very involved. The one thing was the challenge of redefining your role as a doctor, where traditionally there's been this thing of you work and you may be in a private practice or in academia, and then you get to retirement age and now there is no use for you. Now you're supposed to want to step away, supposed to want to move aside so that the next generation can come in, and that often, as people get to that stage of their career, they're trying desperately to hang on to the same knowledge that the younger doctors have and to be as proficient as the younger doctors, and lose sight of… that they now have a different role, that they can now offer their colleagues and the younger generation of doctors the wisdom of many years of experience, so that the coaching and the mentoring began taking precedence for you, I thought, was really beautiful.

01:31:19

But you had to make that mind shift from, I'm not up to date with all the newest stuff to it doesn't matter that I'm not up to date. They can be up to date with that stuff. How they apply that stuff is where I can be of value and of assistance to them. So, watching you sort of slowly, almost reluctantly, move into, I have to let go my primary role as a clinician at the forefront of the cutting-edge knowledge and claim my role as somebody with a lot of experience in mentoring and coaching people and in standing at the bedside and making sense of what is happening to a patient when it's complex. And I've just been so in awe really of your courage in doing that, because I know it hasn't been easy. And then I think the other thing that stands out for me is the societal construct of retirement. That at 65, somehow you're supposed to have worked, worked, worked, worked, saved enough money so that you can now sit back, and yet at 65, you still have… I mean, you're in your 70s now. How old are you now? 

Prof Hoffie Conradie Guest 01:32:26

Seventy-four. 

Dr Maria Christodoulou Host 01:32:27

You still have so much to share and to teach and to learn. So much wisdom born out of all these years that you have worked. By what arbitrary definition is 65 the retirement age? But at the same time, an acknowledgement that it is a different age and stage and that the next generation does need to step into those roles in a particular way, but that you're not obsolete because you've reached retirement age. You're still doing amazing, innovative work and drawing on all those years of experience to make a profound difference. So I hope that at 74, I'm still as involved and still doing stuff that I love and still learning and still doing courses. I definitely won't be cycling an Argus. But I don't feel that my contribution comes to an end because I reach a particular age. The nature of that contribution changes. 

Prof Hoffie Conradie Guest 01:33:20

Ja, ja. 

Dr Maria Christodoulou Host 01:33:24

What's it like for you to hear me say that? 

Prof Hoffie Conradie Guest 01:33:27

I want to touch on that thing of having the latest knowledge and having the latest skills, and I think it's also this thing of… I'm still learning new skills now when I go to the clinic but I'm actively, in a way, asking advice and learning from others. Is that moving away from being the expert, because we all have different expertise and experiences? And always, whenever I worked with older colleagues or younger colleagues and even young doctors, it feels to me that watching them and listening to them, there's always something I can learn. It's having that, oh, but they're doing it this way, maybe I could try that, and then just being aware of your limitations as well. So it's in a sense, moving away from that doctor that has all the expertise and all the knowledge, because we will never have that. Even the most sub-specialized specialist still will not have all the answers. So it's also that mindset of I can't be up to date with everything and I can continue, but I can, as you say, do it in a different way. 

01:34:41

And I think in the coaching and mentoring, I see with the mentors that I mentor or coach there's this anxiety about what should I say, what should I do, and I must give them advice, and it's actually about listening more, I think. Being present, tuning into their feelings and emotions and needs, and then, yeah, we could talk about options. I can then offer options, exactly like you said.

Makes me just think of a book that I read recently Marshall Roseberg’s book on violent communication and I've been really practicing that. Trying to practice this in my personal life, in my work life, and I think that has had quite a profound… Where we really tune into our own needs and emotions and needs and then, as you say, requests rather than demands, but also the other person. Understanding the other person.

You know about my journey with the Human Systems Dynamics Institute and my favourite about turning judgment into curiosity, turning assumptions into questions, turning conflict into mutual exploration and turning defensiveness into self-reflection. 

Dr Maria Christodoulou Host 01:36:01

It's such a beautiful model and so simple. Let's go through it again. So the concept is standing in inquiry. 

Prof Hoffie Conradie Guest 01:36:07

Turn judgment into curiosity, conflict into mutual exploration, and turn defensiveness into self-reflection, and turning assumptions into questions.

Dr Maria Christodoulou Host

Lovely.

Prof Hoffie Conradie Guest

You know, I didn't talk about enneagrams, but I'm an Enneagram 9, so I'm a pleaser. I always want to live in harmony and avoid conflict. But what really has been seminal for me is the concept that in difference there's energy, so the difference makes the difference. So, rather than seeing difference as a conflict, say what's in it here? You've got a different perspective than I have. How can we learn from that? There's energy in that, and how can we harness that energy? 

Dr Maria Christodoulou Host 01:36:58

It does require that we move away from there is a right way and a wrong way. 

Prof Hoffie Conradie Guest 01:37:02

Exactly. That's the polarities, or independent pairs. It's not good or bad, it's both and it's that binary. That's also what I so like about Richard Rohr’s Center for Action and Contemplation - that it moves away from Christianity being the only way. There are many paths to fulfilment, and certainly in the Christian tradition, and that's one way. But there's the good in all of us. Different from, we're born in sin. We actually have that bit of God in us.

Dr Maria Christodoulou Host

Anything we haven't talked about that you'd like to share? 

Prof Hoffie Conradie Guest 01:37:40

I think one thing that… we just touched on it briefly, that the sort of books that I read had such an amazing influence on me. That's one of my regrets, that in my busyness I don't read enough. Eve, my partner, reads at least a book a week and it's wonderful. But it started off with my therapist. The first book he gave me to read was Scott Peck's, The Road Less Travelled. A bit later he gave me Alice Miller's book, the Drama of a Child. It was initially the Drama of the Gifted Child, but it took the rug out of me, you know. I really… because I sort of realized my house was built on sand because I was living to please other people. 

Dr Maria Christodoulou Host 01:38:19

Yeah, I remember that book really clearly. My therapist also recommended I read it many years back. I remember that I had never understood that even narcissism existed on a spectrum and that the other end of the spectrum was the self-effacing humility and that both were equally harmful, actually. 

Prof Hoffie Conradie Guest 01:38:36

Mmm, and I think I'm more to that spectrum. Then the whole concept, we talked about it, about the self-compassion. You know, that's something I'm still learning about. 

Dr Maria Christodoulou Host 01:38:46

The other thing I have here in my notes in front of me is you talked about things that have had an influence on you. There's also all the conferences and international opportunities that you've engaged in, and the rural conference, RUDASA. Say something about what that has meant for you? 

Prof Hoffie Conradie Guest 01:39:02

Ja, that was really amazing and I always… Often in these conferences I went to places that I would never have gone and then I took my bicycle along, which was wonderful. But the conferences, it's the networking and meeting with people that I find so amazing, and seeing what other people are doing and getting their perspectives, and I just found that absolutely so, so, so enriching. The networking, I think, was for me the most important, but there were always a couple of speeches or workshops that were really changing. I always challenge people, students, who come back from a conference and say, so what are you going to change tomorrow as a result of your attending the conference? There's always something that you could take. 

01:39:47

That was really where the rural clinical school really got hold of me is when I attended a conference in Seattle. I think it was 2000 and something, six or so. After what they call Rural WONCA. There were people from America and Australia who had already been involved in the concept of the rural clinical school. So a whole movement now called longitudinal integrated clerkship in many, many medical schools in the world. 

01:40:13

That was, for me, just so enriching and it really inspired me to the concept of the rural clinical school. And I was very fortunate in 2010 to spend, I think, six weeks or so in Australia just traveling around. Actually, as a part of an evaluating team of their rural clinical schools in two states/ provinces, and it was such a remarkable experience interviewing everyone involved, from students to administrators, and that helped me so much with the rural clinical school as well. So that was really, really a privilege and with the rural conference, I try and attend it still if I can. I did last year. It's just an amazing conference. It's all rural healthcare workers and it's just amazing the enthusiasm and the commitment of people from all over. 

Dr Maria Christodoulou Host 01:41:02

What's next for Professor Hoffie Conradie?

Prof Hoffie Conradie Guest 01:41:04

I think the mentoring in the family medicine and the students. That's still in early stages. I'd love to continue with that and see where it takes us and I would love to continue with my coaching practice. I'd love to make that more of my daily work. I really would like to. I'd like to continue with the one day a week at the clinic. It is sometimes a tension for me because I also love spending time with my family and bicycle trips and things, and ja, so I have to be careful to find the balance between the clinical work and the other stuff. And just the nature connection. 

01:41:42

I just love the bird watching and learning more about the flowers and being engaged... Eve has now got into trees, so that's another beautiful thing for me. She teaches me about trees which I haven't been into at all. 

Dr Maria ChristodoulouHost01:41:56

Do you want to say anything about Eve? She's also a doctor, and one of the things I also remember us talking about years ago was that the two of you got to a stage where you were feeling a bit of pressure to decide what conventional form this relationship was going to take and how liberating it was to decide amongst yourselves what you wanted your relationship to be about, and I remember also finding that really inspiring. Tell us about your relationship. 

Prof Hoffie Conradie Guest 01:42:21

Yeah, we've been together now, I think, 20 years. We've always lived apart. So I was in Worcester and then Kleinmond and she's here in Hout Bay, so it's always been a distance relationship, but we see each other frequently and we speak every night on the phone. And it's challenging in a way, but it also gives us the freedom of continuing with our own lives. I think for the moment for Eve, she's just retired and she just stopped working as a doctor and find that quite challenging. 

01:42:50

For me, the big thing about me and Eve is that we were so different. My background and Eve is… Her parents came from Germany. They were German Jews who left just before the Holocaust and came to South Africa, so it was always that refugees coming, and her family is very small. So we come from very different places. We are very different, but that is so enriching for me as well. And that difference that I talked about. I value so much Eve's perspectives that often are very different from mine, but it's enriching and it challenges me and we both work on ourselves. You know personal growth is important. 

Dr Maria Christodoulou Host 01:43:30

It's inspiring. Any takeaway message you would like to leave for the people that listen to our conversation?

Prof Hoffie Conradie Guest

Maybe the other thread in my life is curiosity. There is something in me that always challenges the status quo and wants to explore different ways of doing and different ways of being. I think the challenge for me is being more than doing. Like my curious grandchildren. Just do in the moment is fulfilling and don’t worry so much about the backpack. 

Dr Maria Christodoulou Host 01:44:05

Well, a central guiding theme for our coaching has been this idea of living from that authentic place, living from the core. How close to that would you say you are, at this stage of your life?

Prof Hoffie Conradie Guest 01:44:12

Sjoe, Maria. I’ve certainly progressed on that journey and I must say I'm… More and more, I can come back to the core. Dan Siegel uses the metaphor of a wheel with a hub, the spokes, and then outside all the thoughts and the feelings, but then there's a central place where you can always come back and then more observe those things. It's a journey and it will be a lifelong journey. 

Dr Maria Christodoulou Host 01:44:46

I really just want to acknowledge, Hoffie, that it's been such a privilege to work with you over the years and I think the thing that most stands out for me about you is how, in your own quiet way, without being very obvious about it and without making a big scene about it, you have changed the world in all sorts of ways, and when I think about my career and the influence you've had on me, not only as a role model of things that I've been privileged enough to talk with you about. 

01:45:15

I started at Tygerberg, I was teaching integrative medicine. You were curious in a way that many of our colleagues were not, about what I was doing. And curious enough that you invited me into your academic space in Worcester to talk to the family physicians. We did that. We had that first meeting and then you wanted us to do a bit more of that, and I mean now that has become a longitudinal coaching intervention where all family physicians on the training platform of Stellenbosch University have access to coaching, have regular meetings. As a result of that initiative that you started. And it was just this idea and you just said, come talk to the family physicians and let's try and make it a regular thing. And then we had to get permission for it to be a regular thing, and then we extended that permission beyond the boundaries of the Cape Winelands district and now coaching is an essential part of the family medicine curriculum. So your ability to, I think, be quite forward thinking in how you see the world and to recognize the potential in people and to create a space for them to shine. You certainly did that for me and I'm incredibly grateful for that. So thank you. 

Prof Hoffie Conradie Guest 01:46:32

Thank you, Maria. I appreciate that. Thank you so much. 

Dr Maria Christodoulou Host 01:46:37

I'm Dr Maria Christodoulou and you've been listening to the Awakening Doctor podcast. If you enjoyed this conversation, please share it with your friends, follow Awakening Doctor on Instagram, Facebook and Spotify and go to Apple Podcasts to subscribe, rate and give us a good review. Thank you so much for listening.