In conversation with Dr Con Papadopoulos at ASDP Conference 2024

Dr. Con Papadopoulos reflects on his career blending acute and developmental paediatrics, highlighting the importance of managing complexity, fostering community-wide support for child development, and advancing ASDP’s role in uniting and guiding clinicians toward more dynamic, sustainable care models.

Transcript

Brad 0:11
So I'm Dr. Brad Jongeling, Developmental Paediatrician from Perth, Western Australia, and we've been at the Australasian Society for Developmental Paediatrics Conference in the Gold Coast 2024, in August. And I've got with me the inaugural finance officer Dr Con Papadopoulos. Is that correct, Con? 

Con 0:30
That's one of the roles, a lot. 

Brad 0:31
Of the roles from the society. 

And we're going to chat a little bit with Con about his journey to being a developmental paediatrician and his vision for where the society is going. And some discussion about developmental paediatrics in general. So Con is currently director of the Child Development Service in the Royal North Shore in Sydney. So welcome along Con. Let's just talk a little bit about your journey to being a developmental paediatrician. Can you talk a bit about where you started and how you ended up where you are now? 

Con 1:02
Thank you. It probably was quite serendipitous, actually, when I was doing my training. Community Paediatrics hadn't been quite established at that time, and I was a general paediatrician who felt very comfortable in this area, work without the formal training program yet being established through the college. I then landed a job where I had worked as a fellow at the Child Development Service in southern Sydney at Kogarah and worked part time as a general paediatrician and a developmental paediatrician. Two very separate roles. 

And through that, built up a lot of experience by working within a multi dis team. 

And in many ways a lot of the learning happened over that 5, 10 year period of looking and seeking for knowledge that wasn't necessarily available for me as a trainee. And it's interesting, I just met some other general paediatricians at this conference who feel like they're imposters because their journey is a bit similar, where they are general paediatricians and all their work is developmental and not quite sure what they had missed out on. And they're on a journey of learning like we all are. And I see a lot of similarities with that and myself. So first thing is not to have the fallacy that thinking that you're training as a community paediatrician was going to necessarily put you in stead for that role. And I had worked, I think it must be close to over 20 years now as a developmental paediatrician in a tertiary child development service. I'm the director of the unit at North Shore Hospital, which has a team of psychologists, doctors, allied health and social workers, mainly working in the younger kids with a few sort of older school aged kids, and then still maintaining my acute paediatrics, which includes neonates and emergency resuscitation. 

Brad 3:09
So it sounds fascinating Con. So you currently balance both acute paediatrics with the role developmentally. And of course, a lot of us would have started out that way, but not a lot will continue that. What do you think that's brought to your skills as a developmental paediatrician, having that role as well? 

Con 3:28
Yeah, I'm very mindful of a lot of my colleagues stopping their general Paediatrics. I think you're still continuing a smaller component. 

Brad 3:37
I might stop my on call at nights, on a Wednesday, but otherwise I'm still doing it. 

Con 3:42
And Gehan had stopped his little while ago. I said to a few people just at this conference as we were mingling and talking, the amount of exhaustive effort that is associated with keeping the two roles is offset by the benefits of seeing a lot of the parallels or a different way of seeing things in developmental paediatrics, and acute paediatrics. And I think it increases my awareness of different approaches to a problem, and it also keeps me mentally stimulated. So there are times you could be sick to death of endless bureaucracy and advocacy sitting in an office or working through a computer and going over and being on call and catching a new baby really reminds you of some things. Then you'd have a treacherous weekend on call where there's a lot of acuity and adrenalin associated with sort of some really critical decisions, imminent, timely decisions and then want to regress back into the office. So I actually zig zag those two roles and it works for me. 

Brad 4:50
I think that's a really great insight. I can identify completely with what you're saying that, the acute stuff really provides that difference and that immediacy. But sometimes actually the chronicity and the developmental stuff can be just as amazing or more amazing as well, but it can be exhausting in itself. So, your journey through General Paeds to focusing on developmental paediatrics was serendipitous in setting of you got the role or you actually actively sought out a position in community and child development work. 

Con 5:25
Yeah, I had two roles to choose. There was a general paediatric role or role in the Child Development Service. And I chose the latter. And well, it was end up being four days a week in one role and two days a week in the acute paediatrics, and that's where I've stayed really with four days a week, one day a week. 

Brad 5:45
And so you would have done six, 12 months of child development before you finished months. So as you know, with our trainees at the moment, that most of them would do either Gen Paeds or they would do a combination of Gen Paed and community child health training and I know you've been involved with some of that over time. What do you think are the key skills that a developmental paediatrician needs to be had to work in the area that we work in

Con 6:11
I guess some of the areas relates to what Mick and the group here have been talking about, certain competencies, and I'm not a big fan of passive exposure to child development services being adequate. There's a handful of paediatricians have work with who've had terms at community health services and really hadn't get the benefit that they really needed at that time. And other doctors who have had a luckier role and have done very well. I think what pulls a lot of the general paediatricians who feel that strong affiliation where there is a difficult dilemma that the families going through and to help them through this, I'll call it a chronic disease. If I use a medical model where they where you're working through that with them. And I think there's a lot of paediatricians who actually like that long term partnership with the patients in working that through. And a lot of general paediatricians do that routinely and that often has a developmental framework where there is only a small a handful of a purely medical problems that the general paediatricians work through chronically be it sort of a chronic bowel disease or a or arthropathy or whatnot. But most of the time, the general paediatricians see that partnership and progressive relationship with a lot of developmental areas. 

Brad 7:36
So we've talked at the conference a little bit about developmental framework. But we also talked a bit about complexity as one of those issues that we have to deal with that are a developmental paediatric skill. Is that your view that that there's that mixture between having that lens of saying these children from a developmental framework, but that complexity issue also is part of that? 

Con 8:00
I guess there is. The more you dig into something, the more you'll see it as it's complicated and it depends on, I think where that clinician tends to see things, some people oversimplify developmental paediatrics or even acute paediatrics, and other clinicians keep digging and digging and digging. I'm not sure how far they dig, and sometimes they dig themselves too far. And one of the things that I think we're trying to get through here is that by working with some of the complicated factors to simplify it in a way that's quite workable and tangible, not so much that you'll bog yourself down and you're enmeshed into something and then you're feeling quite stuck and not to the stage where you've oversimplified the situation and think that, well, it's  I've done my job and the rest of it's going to sort itself out. So it's almost like a bell curve, I feel. So for me, part of the things that in developmental paediatrics is actually working with something that's tricky, but not over complicated in a way that you can't get yourself and the family bogged and also not oversimplifying it. 

Brad 9:11
So the topic of the convention that's obviously been embracing complexity, finding simplicity. So you're trying to find that middle ground aren't you in terms of how you assess a family and a child within that context. So as developmental paediatricians, we see a wide variety of presenting issues, whether they be concerns about children's attention regulation or their behaviour or their social interaction. Where you see the biggest challenges in being a developmental paediatrician? And I'm happy for you to talk about kind of cases or specific diagnoses or in fact the broad brushstroke. 

Con 9:47
I think the biggest challenge relates to the ability to put yourself at that bell curve where you're managing something tricky without getting bogged down. That's what I see it. So if you start to obtain a clinical picture and you start to get quite lost to it, how to start to work with a few factors. First, then move forward and then continue to move forward. So that's what, I would think is the biggest skill within this job is managing the complexity with a a few clusters that you can manage and then reassess and reassess. 

Brad 10:26
So I think it's been about 12 years since the first meeting of the Australasian Society of Developmental Paediatrics and NBPSA, which was held not far from here. And I think you were the inaugural, was it secretary or Treasurer, 

Con 10:39
Yeah, I was the inaugural Treasurer and part of the original committee, the foundation committee. 

Brad 10:45
So, you know, I think we would all agree that the society's been really important for supporting clinicians in this area, building friendships, but also providing that place that we can come to really feel like we're part of a community and probably align our practices a little bit. But I'm really interested in your thoughts as to what the society has brought to developmental paediatrics. 

Con 11:11
I think one of the original goals was a space where developmental paediatricians could talk shop together. To my knowledge, prior to this society, there wasn't a forum to do that. The college hadn't quite met that, and the linkages between myself and your self and other colleagues weren't there. And then I think as we started to meet those needs, we then found in a broader group of general paediatricians who needed similar ways to discuss and and think things. I think that in some of the discussions with Michael and Gehan and Jane was that the wide variety of practice felt a little bit like cowboy country, where people worked in a way that they saw best without having enough reflection or science through that. So I think the society first helped developmental paediatricians and then more so a lot of general paediatricians in thinking about the same space. Sometimes within the group, there's certain clusters that people need additional help and it could be within working with hospital bureaucracy like we do or others who are working in private practice. But on the whole, it's that whole ability of affirming your practice with your colleagues to understand is that variation the way you choose to, or do you have better options in in the way you treat your patients? 

Brad 12:34
So I think that speaks to that community of practice and it's really valuable to have those discussions and realign yourself with what others are doing. And I think we would agree that we learn a lot from each other in that process. Just coming back a little bit to your career at the moment, I think correct me if I'm wrong, you also worked within a group that was focused on intellectual disability with psychiatry at one stage. Can you talk a little bit about what you learned from that role? 

Con 13:00
Yeah. So whilst we were small isolated groups in developmental paediatricians, there's also been another isolated group called Developmental Psychiatrists who had no home as well. And Australia child and adolescent psychiatrists don't have exposure to that training program. So the hub that I was working through was the epicentre that helped bring developmental psychiatry, mainly from the UK and a few other places as a hub within Australia. And people like David Dosseter and Michael Fairly and Julian Troller were really incredible people who didn't have a hub and we joined those hubs with the developmental paediatricians back in in Kohorah, and that's continued to extend itself in parallel to to our society. 

Brad 14:01
And you did some case management with those clinicians. Can you talk a little bit about how the value of each discipline has made a difference to a family? 

Con 14:11
Yea,So  some of that linear thoughts that I was trained as a developmental paediatrician was quite different to the approaches of a psychiatrist, developmental psychiatrist Bruce Chenoweth is an invaluable colleague who worked in the office next to me for many years and we reflected on practice and I we did some joint clinics together and as we were sharing ideas with the family and talking about ways forward, it really opened up my eyes about some different ways to work. And then some of these themes are coming through in the conference now, but I wasn't aware of them previously. So I think that ASDP is actually bridging some of the gaps that I went through in the past, and I'm really proud of society for that. 

Brad 15:02
So the society is bringing A different lens here, which is important, isn't it? So I think you'd have to say that we're in a really challenging environment at the moment, post-COVID and lots of children on waitlists with complex issues, many questions around neurodevelopmental issues, whether it be child referred with autism or ADHD or other developmental issues, huge waitlists across sites and various funding models for them. And that's putting a lot of pressure on Paeds developmental Paeds. It's particularly including in private, I mean, what do you think is the way forward to manage these issues, these emerging issues? 

Con 15:39
I think overarching that is a society that is more aware and more interested in actually the welfare of their children. So if I think about the threshold for parents presenting their child to a doctor in the eighties, compared to now, more families are more aware and looking at variations and better awareness of early intervention. So it's really created a tsunami for healthy development. And if that all ends up on the doctor's lap, I think we would never meet the need. So I feel that there's a broader community approach that needs to happen in parallel rather than to be a doctor problem. And the same type of thing you talk about with obesity and in other important issues. So I think there is a a whole of community things, and I think ASDP can take a bigger role in that as we support our clinicians. Talking about waiting lists is probably not the right discussion, but talking about the way society helps children. There's another thing that's happening in parallel that I seen where as we, Michael beautifully covered the talk on complexity and a lot of clinicians had a real aha moment about that. I see a couple of things running in parallel which we need to consider that wasn't talked in this talk. The other thing that runs in parallel with this endless push in our society for efficiency and outcomes, and in doing that, it's sort of being more work, it's less time and that's seen that pressure falling on the paediatricians as well as it's falling in other areas of government employees in different areas. And then we've also got a society where as a whole, sometimes a little bit more critical when something doesn't go wrong. We're been much better trained in thinking about what's preventable versus inevitable. But as we always worry too much about what's being preventable, we can be quite critical of each other. And sometimes I think society where you've done a really good job with helping someone, but a parent could be quite critical about what's not done, or the school teachers could do that. So not only dealing with complexity. We're dealing with endless volumes of efficiency and then also an increased sense of critical ness about that. And that triad is the current environment that we're in. Does it makes sense. 

Brad 18:08
Yeah, it does. I think the challenge is working a way forward through that, although I agree entirely with you about changing expectations within community and a community approach to this tsunami of concern that we're kind of dealing with. And from my perspective, the risk of inadvertent or inappropriate or over diagnosis at times, which I think is somewhat of a risk and I don't mean necessarily within our clinicians specifically. Okay. So, you know, we talked to a bit about complexity in your journey. I want to just move on to have a little chat about where you see things going in the next five years, both for the profession but also potentially for you. And where do you see developmental paediatrics being over the next five years? So the challenges, the opportunities and perhaps the risks. 

Con 18:59
I think the current model of about being doctor dependent has reached its limits per say. And even though we've got a lot more people working in this area, the unmet need is still very significant. So the future would I would tend to relate about having a healthier society outside of the health system per say. We had some nice talks about gaming, some of the recent conversations about some new realisations, such the book The Anxious Generation So actually to be part of a healthier population through some lobbying makes a lot more sense just in some ways where some really successful lobbying has been done about foetal alcohol spectrum disorder, rather than being a medical problem, being a more of a preventable community health problem. I think we have to look at that balance now. We've got a lot of private clinicians who are flat out trying to make direct family needs, but there's got to be. Another group is also working with government to create a healthier population of young kids. 

Brad 20:03
And as you said before, just mean more developmental paediatricians and more therapists. We're really looking at a whole of community and all of government approaches to build up healthy, resilient families and children. Well, it's been a really interesting journey. You haven't answered where you are going to be in five years. Con What do you see for that? and what extra contribution do you think you'll make in terms of both society and developmental paediatrics Over the next five years? 

Con 20:29
Tricky. One of the things that I'm actively in and what should be done within that five year period is the model of child assessment services in New South Wales was sort of an outdated model and we'd been part of a working with a government group called ACI with the New South Wales Health Government in looking at a more efficient and more sensible way of providing assessments but not over treating and not under treating in those areas. And I think that will come to fruition over the next five years with having a more dynamic model of care. But after that I'm not quite sure where I'd be. 

Brad 21:10
Okay, well, thanks very much Con, It's been really great to chat to you and I'm sure we'll see you around of any of these conferences and and then on in the next few years and I'll look forward to chatting to you more again. So thanks a lot. 

Con 21:20
Thank you.