Conversations on the Road to Ballet Class…
It was those conversations that fostered a career in reducing inequities in access, improving the quality of general practice care in women’s sexual and reproductive health, prevention, the early detection of cancer, and antimicrobial stewardship.
Professor Danielle Mazza is an internationally distinguished general practice clinician researcher and Head of the Department of General Practice at Monash University. Her research and leadership have been highly influential in reducing inequities in access and improving the quality of clinical care delivered in general practice in women’s sexual and reproductive health, preventive care, the early detection of cancer and antimicrobial stewardship. A strong proponent of evidence-based care, she has led and contributed to the development and implementation of key general practice guidelines used nationwide and provides expert advice to professional, government and policy groups nationally and around the world.
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“My father used to drive me to my ballet classes and he used to say, ‘Danni, you need to do medicine, you’d be really good, you need to do it because we weren’t able to do it, you’ve got the opportunity, you’ve got to take advantage.’ He gave me good advice because it’s turned out to be a great career.”
Today we are talking to Danielle Mazza in Australia, tell us about your interest in medicine and where it began.
Danielle Mazza: I got into medicine because my father told me that I should. I’m the eldest daughter of a migrant family to Australia. My father used to drive me to my ballet classes and he used to say, “Danni, you need to do medicine, you’d be really good, you need to do it because we weren’t able to do it, you’ve got the opportunity, you’ve got to take advantage.” He gave me good advice because it’s turned out to be a great career.
DMacA: What a wonderful story…
DM: My mother is one of five children, four girls and one boy. My uncle became a renal physician but all my mother’s four female siblings became teachers. As a woman, you could either become a teacher or a nurse, not a doctor. And so when I became a doctor and then I went into academia, my grandmother said, “What are you doing? Why are you going into academia? Your trained to be a doctor, why aren’t you in clinical practice?” It was quite difficult to explain that I had also chosen teaching and research.
DMacA: Tell me about medical school, the things that interested you, and what brought you into a career in family medicine?
DM: I was interested by lots of things but never really interested in the technicalities of procedures, surgery, and things like that. I enjoyed the aspects of medicine that involved building relationships with patients and general practice seemed to encompass so many of the things that I really enjoyed about clinical medicine and the breadth of it, and particularly the continuity of care. But, it was really the capacity to build relationships with people and to use that in a therapeutic way that was so attractive.
“…it felt like there was this Tsunami of disease and early on in my career, I felt quite helpless. I was dealing with things that could be prevented and the more I learned about women’s health, the more I learned about the sociodemographic impact of women’s lives on their health.”
DMacA: Your major interest is in women’s health, where you’ve done an enormous amount of work. Tell us about that development.
DM: I had some watershed moments in my training that opened my eyes to issues in women’s health. I found my obstetrics training very dogmatic and very lacking in evidence and very focused on maternity care with very little gynaecology. I did my elective at the London Hospital (UK) with a doctor called Wendy Savage
I had read a book that she had written. She was an obstetrician working in the East End of London and, I can’t remember the specifics now, but she had been kind of de-registered or told by the hospital where she worked that she wasn’t able to practise because the way she practised was unconventional. And her patients marched in the streets to have her reinstated at the hospital. And so I wrote to her saying that I would like to come and do an elective with her. She was a bit surprised and she kept asking me why I was there. I said that it was because all I hear is this dogma but you do things differently and I want to understand why. And she talked to me. I was very impressed by her commitment to working with disadvantaged women in the East End. Her patients were mainly Bangladeshi women. She had also spent part of her career working in Africa where there was a lot of maternal mortality and fetal mortality. And some of the things she did, like late term abortions, I watched her carry those out in her practice. I asked her lots of questions, and she told me about her commitment to women and putting women first and, and how the impact of practising in Africa had influenced her in the way she worked. She was someone who made a really big impression on me. ( See: BMJ Confidential ) I was also fortunate to be supervised at one point in my career by a fantastic psychiatrist, Lorraine Dennerstein, who worked in the area of women’s health, in particular in relation to menopause and mental health. Lorraine was able to research and undertake practice in areas that were very stigmatized and had not really been talked about in my medical career to date. Both those women made a really big impact on me and influenced my career direction a great deal.
DMacA: Let me ask you about that a little bit further. Did you write to her after she had been in the news or did she become infamous after that?
DM: All of that period in Wendy’s career had passed by then, it was being written about, and I had read a book about it. At that point I wrote to her and I thought she’d be really good to go and learn from. I’ve always been impressed by people who have challenged the status quo and I’ve gravitated towards them. (See: BMJ Group Lifetime Achievement Award)
“My secret is having the fantastic people that I work with. Nothing comes easily. We got funding for SPHERE on our third application, and I’ve always been inspired by a colleague who kept putting in a research grant application and the seventh time, she got it.”
https://www.racgp.org.au/clinical-resources/clinical-guidelines/key-racgp-guidelines/view-all-racgp-guidelines/preventive-activities-in-general-practice/what-s-new-in-the-10th-ed-red-book
DMacA: Are you someone who challenges the status quo?
DM: I hope so. Yes. That’s the contribution that I want to make. I want to make change and I want to improve things. When I went into clinical general practice, as I tell my medical students, it felt like there was this Tsunami of disease coming towards me and early on in my career, I felt quite helpless. I was dealing with things that could be prevented. The more I learned about women’s health, the more I learned about the sociodemographic factors that had a profound impact of women’s lives and on their health. That determined my career path and I’ve done a lot of work in preventive care. Recently I’ve been chairing the update of the College of GP’s in Australia’s guidelines. They are called the Red Book and national preventive care guidelines. It’s been quite a challenge. I’ve always liked working in the area of prevention because I think so much good can be done to stave off chronic disease and the impact of disease in people’s lives.
DMacA: Chairing the guideline committee is pretty challenging as well. Guidelines are guidelines rather than rule books, and they get a bit of resistance. Do you find much resistance?
DM: At various points people may think that guidelines are not helpful. That’s been something that I’ve tried to address through my work. On the one hand I focus a lot on women’s health but, on the other hand, a lot of my work is about developing guidelines that are more useful as summaries of the evidence, a source of information that can help in clinical practice. I focus a lot on implementation and how to make things more implementable, more realistic, and more pragmatic, particularly for GPs.
DMacA: Let’s go back a little to talk about women’s health, because you’re very involved in SPHERE. Tell us about SPHERE.
DM: SPHERE is the centre of research excellence, that I lead. This is an initiative of our National Health and Medical Research Council in Australia which is the equivalent of the NIHR in the UK and CIHR in Canada. Its a five year program of work with two aims. The first is to push the evidence along in that particular area, and you have to justify why the clinical or health service area is of particular significance but, it’s also about workforce capacity building and building the next generation of researchers in that space. I’ve been very fortunate in that we’ve had five years of funding for SPHERE and we’ve just been successful in receiving another round of funding.
SPHERE is now entering its sixth year and I’ve had a fabulous time working with really amazing collaborators not only in Australia but also internationally and I think it really helped to push the agenda forward in women’s sexual and reproductive health in Australia.
DMacA: You’ve attracted an enormous amount of research money. The last figure I saw was 48 million and perhaps it’s more than that now. What is your secret?
DM: My secret is working with fantastic people. Nothing comes easily. We got funding for SPHERE on our third application, and I’ve always been inspired by a colleague who kept putting in a research grant application and the seventh time, she got it.
Constant refinement, a lot of stakeholder engagement, a lot of really effective partnerships with people, and having a great team. Grant writing, I was telling my team this morning, is a craft that you learn but in general practice, like many other clinical areas, we don’t really learn those skills. It’s all about writing and communication and making things easily digestible. I’ve learned from the experts and made it an exercise in vigorous concise writing with some really good figures and explanations to engage reviewers. And, it’s also very easy for me to justify the significance of the work that I do. Women’s sexual and reproductive health is quite fundamental to the trajectory of women’s lives so I can make a strong argument about why they should fund me.
“My argument or proposition to GPs is that we should be focused on managing the symptoms and start hormonal treatments early. Don’t wait for a diagnosis because a definitive diagnosis can only come with laparoscopy and who knows when they’re going to get a laparoscopy.”
https://www.spherecre.org
DMacA: You talked about the importance of sexual and reproductive health but, in terms of women’s health, I’d like to ask you about an area that’s really topical at the moment and a huge challenge to general practice, and that’s endometriosis. Where are we going with endometriosis access at the moment?
DM: Just recently I’ve taken an increased interest in this area. I’ve been on the National Australian Endometriosis Guideline Group in Australia representing general practice. And, I’ve also just been awarded a large grant to develop and implement an endometriosis and pelvic pain management plan for general practice. There are very high rates of endometriosis in the community and there’s a lot of delay in the diagnostic process which leads to a lot of chronic symptomatology in women and poor quality of life. Traditionally a lot of the responsibility has been attributed to poor performance by GPs who don’t pick up endometriosis, don’t diagnose it and many women are afflicted by this long delay in getting an explanation for their symptoms. What really concerns me is the related long delay in the management and I think that’s because GPs are concerned about the need to give women a diagnosis. It may or may not be endometriosis but the management is readily accessible to us. For example, if a teenage girl presents with her mum with very bad period pain and they’re looking for a solution, they may be offered a non-steroidal or the pill, or they might go away and think about it but perhaps don’t come back. They could be offered, what we know to be very effective, a long acting reversible contraception like a progestogen containing IUD. If we start these kinds of hormonal treatments, it will be interesting to see in longitudinal cohort studies whether we can actually defray the burden in morbidity that occurs with the onset of endometriosis and the delayed diagnosis. My argument or proposition to GPs is that we should be focused on managing the symptoms and start hormonal treatments early. Don’t wait for a diagnosis because a definitive diagnosis can only come with laparoscopy and who knows when they’re going to get a laparoscopy.
I remember having discussions with Chris Del Mar, someone who made a very big impression on me early in my career. He said, “You know, you do research, and it’s like throwing a pebble into a pond and waiting for the ripples to hit the shore.”
DMacA: We’ve talked about clinical practice and we’ve talked about research. Another area is your involvement with government. That’s another huge challenge. Tell us about your work with government.
DM: That’s been a very rewarding part of my work with SPHERE, particularly in the last few years, where we do research that actually has an impact. I remember having discussions with Chris Del Mar, someone who made a very big impression on me early in my career. He said, “You know, you do research, and it’s like throwing a pebble into a pond and waiting for the ripples to hit the shore.” And, I thought, that was quite frustrating. So, I’ve made a very big effort with SPHERE to have much more of a policy impact with government. A lot of that is about building relationships with people, going to see a minister, pursuing them until they give you half an hour, having their chief of staff on the contact list in your phone and texting and talking and having regular catch ups with them. What I’ve been doing is presenting the outcomes of our research and, through our SPHERE Coalition, presenting solutions to them. Politicians are bombarded with problems but they’re not often given the solution. The way we’ve been approaching that is by building a coalition of people who are interested in women’s sexual and reproductive health and using the multidisciplinary nature of that coalition to get all of the different perspectives within the healthcare system around the solution and then building consensus where we’re all talking on the same page because we’ve worked out the solution together. If we are all offering that to government, it’s a much stronger case. So, we’ve had a quite a lot of success in terms of building in government support for telehealth, which was quite novel in sexual and reproductive health care, and other initiatives that we’ve put forward.
DMacA: And, of course, you’ve brought your work beyond national level because you work with the UN on the sustainable goals.
DM: Yes, just recently I have been working with the W.H.O. particularly in the area of preconception care, where we’ve been talking about the Australian approach and possible solutions. I think the areas that I work in, which are around improving access to services in women’s sexual and reproductive health, are ones that are critical right around the world.
DMacA: And, finally, you’ve had a lot of awards, including national awards in recognition of your work
DM: Yes, I was very honoured to have been appointed a Member of the Order of Australia (AM) last year and to have been made a Fellow of the Australian Academy of Health and Medical Sciences.
DMacA: And you’ve written a book and what caught my attention is that it’s been translated into both Mandarin and Russian. That must have been a thrill.
DM: Yes it was a great honour having my book “Women’s Health in General Practice” translated and going over to China to launch it. I followed in the footsteps of John Murtagh, who’s also been a great mentor for me and his textbook of general practice (Murtagh’s General Practice) had been translated into Chinese and mine followed. I travelled to China with John for the launch and to be able to have that kind of impact has been something that I really treasure.
DMacA: You have certainly had an impact. It’s been fun chatting to. Thank you very much for sharing your life and career. Thank you very much indeed. Thanks so much.
