Dr. Shiromi Podcast

Hello, and welcome to Episode 16 of Triumph Beyond Trauma.
Today for tactical yoga, Australia is the official start of launch week. So if
you are listening in the week of June 18 to 25, 20 24. You can now head over to
my website, tacticalyogaaustralia.com. To check out my program, the first
responder mental wellness method.

I think that this program is amazing. It's the only one of its
kind that I'm aware of, that has been created by a first responder. For other
first responders, veterans and frontline workers. The program is entirely
online and self-paced. If you have difficulty reading a lot of texts, I've got
your back there. Everything is either audio or a video track. There is also a
PDF workbook that you'll receive to use alongside, your progress throughout the
program. The program consists. , a little. First responder cycle. Psychology. .
Breathwork mindfulness. Yoga of. Of course. And ways to implement. These into
your. Everyday life.

If you want to take. Take a deep dive into the program. And
what it's all about. Check. Out episode. For. In season one. Where I explain.
Plain the program in a lot more detail. Something that I have changed. This
time. Around is the. The pricing structure. of the. Program. So. I've dropped
the price of the program only.

So if you want to have access just to the program and you don't
want to see my face each week or have a live practice with me. You can join for
just $247, which is. A crazy bargain, but. The reason I did this is because I
know that this program is beneficial to the mental wellness of first
responders, veterans, and frontline workers. I know that this program. We'll
help to reduce the symptoms of stress and anxiety.

And I want as many of my brothers and sisters in the first
responder veteran and frontline worker communities to have access to it as
possible. In this time. time. of a cost of living. Crisis. If you do want
access to everything, the price of $597, uh, Australian remains the same.

And with that, you get group coaching and live practices, as
well as everything else that you get. , with the program only so that you can
really fast forward your progress. I could talk about it all day, but I won't
because the reason you're here is for my amazing guest this week, Dr. Shiromi.
Dr.

Shiromi has been a doctor for 15 years. She obtained her
medical degree from Melbourne's prestigious Monash university and completed her
internship and residency at Alfred health. She loves chatting with patients,
listening to their unique stories and helping them get back on track so they
can live life as the best. version of themselves.

After completing her specialist training and becoming a fellow
of the Royal Australian college of general practitioners. She advanced her
skills and completed further training in psychological strategies, subsequently
establishing a high school mental wellbeing program.

Dr. Shiromi is passionate about mental health and feels
privileged to help a patients who courageously step into her office to seek
help. She prides herself on supporting patients make positive lifestyle
changes. Getting an established skillset to help manage worries. And most
importantly, find a sense of relief that will, they will all be okay. And most
importantly, find a sense of relief that all will be okay. Dr. Sharmi is a
strong advocate for empowering her patients to stay informed and engaged paving
the way for accelerated progress and better health outcomes.

Dr. Shiromi is a leader for change and innovation. She's a
founder and CEO of the cloud GP. The signature course is an online self
directed mental health program that helps patients overcome symptoms of
depression and anxiety. While they wait to see a psychologist. The cloud GPS
mission is to provide access to timely evidence-based GP led mental health
support for all Australians.

This episode, and this conversation is so important. One of the
reasons that I wanted to start this podcast was to increase the mental health
literacy of first responders, veterans, and frontline workers. If you've
listened to a few episodes, you'll know that I refer to a lot of my own
experiences and I do this because I believe it is so important to speak out
about it. If I can come here and I can recover loudly in a way that shows
others, that you can do the same.

Hopefully we can prevent some people from struggling or worse.
Dying silently.

One thing I'd like to address before we start is I mentioned a
statistic in the episode that nine people a week die by suicide in Australia.
And that was incorrect. It's actually an average of nine people a day in
Australia, dying by suicide. And I really wish I was right the first time. But
unfortunately this is what's happening. These numbers are people that people
would love and care for.

So please be kind to each other, call your friends and family.
Love each other as hard as he can. And please, please. Take early action for
mental health. If not early, then as soon as you feel like something isn't
quite right, please just go.

Okay. That's my rant over. Please enjoy this incredible
episode. with Dr. Shiromi the cloud GP.

Welcome to Triumph
Beyond Trauma, the podcast that explores journeys of resilience and hope. I'm
Rosie Skene a yoga and breathwork teacher and founder of Tactical Yoga
Australia. As a former soldier's wife, mum to three beautiful kids and a
medically retired NSW police officer with PTSD, I understand the challenges of
navigating mental health in the first responder and veteran community.

Join us for incredible stories from individuals who've
confronted the depths of mental illness and discovered their path to happiness
and purpose, as well as solo episodes and expert discussions. Together, we'll
uncover the tools to help you navigate your journey toward a brighter future.
Whether you're looking for helpful insights, practical tips, or just a friendly
reminder that you're not alone, Triumph Beyond Trauma has got your back.

You matter, and your journey to a happier, more meaningful life
starts right here.

Rosie Skene:

Welcome
to Triumph Beyond Trauma, Dr. Shiromi Thank you so much for joining

Dr. Shiromi:

me
today. Thank you so much for having me. It's a pleasure to be here.

Rosie Skene:

I would
like to start off with, , talking a little bit about you actually. And I know
that you're a GP and, but you have a specialized interest in mental health and
I'm just wondering how that all came about for you.

Dr. Shiromi:

Yeah, of
course. Um, so I've always had a passion for medicine. , I love talking to
people and hearing their stories. And I was a bit of a nerdy science sort of
person in high school. So I got into medicine at Monash. , and you know, did
the rotations after, after I completed my medical degree, I was at the Alfred
hospital in Melbourne.

And did a bit of emergency and did obstetrics and did, ,
inpatient mental health and wellbeing. And I really enjoyed it. Um, you know,
mental health and probably, , obstetrics are my two contenders early on, but
then I realized over time that I'm someone that needs my sleep. Babies are not
born nine to five.

So mental health was a lot more conducive to lifestyle and
LinkedIn with my, with my joy. , and then general practice. I love general
practice, mental health, and especially. Early intervention mental health.
That's getting in when, um, you know, we first start seeing the cracks to
appear and helping you turn things around quickly at those early stages.

Um, and that's simply because of the warm and fuzzy that I
would get. Like, it's so lovely to have someone come in and often when people
come in to see us, they're like, Things aren't great. Their marriage might be
on the rocks or they might be called in for a performance review, or they've
been arguing and fighting with the kids all the time, or feeling a shell of
themselves.

And with a bit of hard work and a bit of psychological
strategies and lifestyle change, we can often turn things around in three to
six months time. So as a GP, there is nothing better than doing that review
consult in a three to six month mark and hearing people that they've, you know,
Their relationships are better.

They're doing better at work. They've got a promotion or that
they're just feeling themselves and, you know, happy with life. So that's where
my passion for mental health stems from.

Rosie Skene:

Oh, that
is, , yeah, beautiful. And I know what you're saying when you get that little
buzz, you know, from helping people.

Cause I get that too, you know, in a different way, but I still
get that. Yeah.

Dr. Shiromi:

We all
have to do stuff that, you know, every day at work.

Rosie Skene:

, So
you're just saying that you can, you feel like in about three to six months,
some people can turn around. Is that dependent on how fast, you know, how deep
their mental health issues are how early they, uh, seek help?

Dr. Shiromi:

Yeah,
for sure. There, there's lots of factors involved. Um, you know, I think the
three to six month I've seen. We might not be able to turn everything around,
but most certainly with majority of people, we can make significant change and
get people on the right track. Yeah. Look, I always told my patients, um, and
even, you know, it comes to do with follow up in terms of catching up with me
later.

Cause mental health is a, you know, depression, anxiety, or
chronic health conditions. They're not like your, I don't know, a chest
infection or, you know, your new tract infection. We just throw antibiotics
for, and then a week later you're feeling better. It can come back over time.
And I often tell my patients that if I can reach your hand, I can pull you out
of a hole.

a lot easier than if you're in a deep, deep hole. And don't get
me wrong. I've got ladders and pulleys and all the works to get you out of any
hole that you're in, no matter where you are on the spectrum of things. But by
golly, it's so much easier if we see people earlier in terms of helping them,
you know, change course and turn things around.

Um, but we can help you at any point, but yeah, that's why. You
know, we talk about so much about as GPs, looking after health from a proactive
standpoint, rather than a reactive standpoint in that we want to try and stop
you from feeling unwell, getting to that point of crisis, if ideally we can.

And it's the same as going to the gym. Like a lot of us go to
the gym and do a physical workout. And that's not necessarily because we've had
a heart attack or a stroke, is it? It's because we want to prevent that stuff
down the track. So that's how we have to start viewing, , mental health and
wellbeing in general as well, I think.

Okay.

Rosie Skene:

Yeah, I
could not agree more. Uh, proactive approach to mental health is definitely so
important. And, you know, for my listeners being first responders, veterans,
and the families and friends of those people, , that's a couple of industries
where I really think it's so important. So in relation to early intervention
and recognizing the signs and symptoms, Um, you know, for me, I'm going to tell
a little story about me.

I didn't know I had zero mental health literacy at all. Like I
just thought, you know, mental health from what I dealt with as a police
officer was just outbursts, you know, uh, to the point where. You know, they
were so deep with their mental illness that the police would get called and
that's where I would be, you know, that's what I would say.

I didn't see anything else in the lead up to those events. Um,
and I think that's where a lot of us can struggle because we can't, we don't
know, uh, the early signs and symptoms. So I was hoping that maybe you could
discuss some of those for, um, you know, the top three for police is anxiety,
depression, and PTSD, of course.

Um, so are you able to speak to that and what's some early.
Symptoms that might present

Dr. Shiromi:

with it.
I think, and look, first of all, I think it's, let's just normalize that
struggle of trying to figure out what's a bad day. What's a bad week about what
actually is a mental health illness as such. It can be very hard to sort of
quantify that in terms of.

Um, let's start with depression, for instance, symptoms that
can be commonly experienced to things like sadness, uh, lack of motivation,
which we called anhedonia in, in medicine. So it's that feeling of you used to
go for a bike ride and, or used to catch up with your friends for coffee. And
now you just don't want to anymore.

You can't be bothered doing those things that you used to enjoy
a lot. Uh, things like reduction in energy, fatigue, uh, feelings of
worthlessness and guilt and blame. Decreasing concentration, appetite changes.
And then we obviously talk about things like suicidal ideation or suicidal
thoughts or feelings of wanting to end your life, uh, from an anxiety point of
view, dealing with things like excessive worry.

Uh, so not just that worry in the moment that, that worry that
keeps you up at night and that takes over your day and your functioning, uh,
again, fatigue. Reduction in concentration, uh, sleep disturbance,
irritability, and just to overall impact on your activities of daily living,
whether it be your relationships or leaving the house, uh, you know, there can
be most certainly a crossover with anxiety and depression.

Sometimes people present with a bit of a mishmash of symptoms.
And I commonly tell my patients, look, you might start with one, but they're
almost cousins of each other. So if you find these other symptoms, you know,
creeping in, come and have a chat to us about it. I think one of the important
things to note is that even though people might not know exactly what
depression is or what exactly anxiety is, they often have a gut feeling that
something is up and that something is wrong and they're not functioning at
their best.

And I often tell people not to try and get too caught up on the
diagnostic process of, you know, is this depression or anxiety? We don't do
that with anything else in medicine. You know, you don't need to. worry about
diagnosing yourself with appendicitis when you come in with severe abdominal
pain, you just come in with the severe abdominal pain and say to me, my tummy
hurts.

And then it's my job to kind of ask the questions and try and
figure out what's going on, whether it be, you know, appendicitis or gallstone
or endometriosis or whatever it is. So let's try and look at mental health as,
as that, as you coming in to have a chat to us, to sort out what's going on
now, most certainly those symptoms I mentioned can be a part of, uh, Numerous,
um, different conditions and that can make it tricky as well.

So part of our job in GP land is to rule out the, um, you know,
and I put it in inverted commas, medical conditions that could also mimic
depression or anxiety or another mental health condition, things like low iron
or thyroid dysfunction. And sometimes other mental health disorders like
bipolar, for instance, where you get these ebbs and flows of highs and lows.

And so our job is to take a comprehensive history and to have a
chat to you. So yeah, most certainly I think we need to bring about more
awareness about the symptoms and, and what people are experiencing, but also
not let people know that they don't need to have, um, you know, a solidified
diagnosis and wait for things to get really awful before they come in.

Rosie Skene:

Yeah,

Dr. Shiromi:

that's
great.

Rosie Skene:

I, yeah,
I think, um, when I went to see my GP, you know, I was so lucky because she was
great. Um, and I had a couple of things I wanted to say about, and I had like a
little shopping list that I was there for, you know, like, okay, well, what do
you want to talk about first?

I'm like, oh, I think it's actually my mental health. And I
still wasn't not convinced, but, um, I still wasn't sure that there was
anything wrong, but I'm so glad because of, you know, Turned out there was
quite a bit going on that I sort of didn't realize I was pushing to the side.
So, but that first appointment for me, I think I actually went in with a
shopping list because, um, I was nervous and anxious about it, to be honest
with you and I think to have that realization as any human, whatever job you do
that, you know, something might be right and need a little bit of help.

Especially for first responders and veterans, because there is
so much stigma around, you know, mental health and what impacts that can have
or may have for your career. So, , I was wondering if you could walk us through
maybe what, , your first appointment might look like with a GP and having that
conversation from the very start.

Dr. Shiromi:

Yeah,
for sure. And you know, props to you for bringing it up because it is a really
hard topic of discussion. And you mentioned that you brought it up first and
that's probably not the norm. What happens with

Is that everything else we kind of get through. And then while
someone's having a. You know, I'm examining their knee or, you know, after
they're getting changed after their pap smear, they might go off, you know,
life's rough at the moment.

And it's hard to sometimes delineate whether that's just
conversation of the day or whether that's another presenting condition. Um, and
something that they want to actually talk about and get to the bottom of. , and
that's a really normal thing to do when you're feeling nervous and apprehensive
worried about the judgment and all of that as well.

But I think one tip to begin with would be to try and it. Book
a double appointment to begin with. So make sure there's enough time because
then you don't feel like you're rushed to say everything and get everything
out. Cause it's a hard, it's tricky topic to talk about. Where do you start
often? You know, it's not this, Oh, three days ago I had this and then this
symptom happened and this, it's just, you don't even know where to begin with
this stuff.

So book yourself a double appointment and then just try and
come in with that issue. Like literally come in and just say, um, you know, I'm
struggling a bit with my mental health and I thought we could have a chat. ,
and then, you know, we can help you with. What does say, and, you know,
questions and all of that sort of thing, but try and book a double appointment
and then just come in with that one topic and make it very clear that that's
what we're here to talk about.

Uh, we've got a resource which will pop in the show notes. Um,
that's called the mental health care plan preparation resource, and it actually
goes through all the. Not all, but most of the questions we ask as GPs to
patients in terms of that mental health, initial mental health consult. And it
goes to what we're going to ask, because I think that's another part of the
worry is just not knowing what someone is going to ask and not feeling like you
have all the information, but we'll go through and we'll ask a lot of, um, sort
of like a symptom checklist for the symptoms that we went, went, went through
before we'll do symptoms of other mental health conditions.

So we can rule them out. And then we'll ask about a bit of a
systems review. So we'll ask about other health stuff that may seem completely
unrelated, but we are there, you know, searching to see whether or not your
symptoms could be caused by dietary deficiency or, you know, a rheumatological
disease or something else going on because we need to rule those things out.

In medicine it's very much about treating the cause. So the
first part of the puzzle is to figure out, okay, what exactly is causing this?
Uh, we'll often ask, you know, history about lifestyle factors. So about diet,
exercise and sleep, uh, you know, what your work's like and who you live with
and social dynamics and all those sorts of things, because with mental health
and wellbeing, all of those factors into play with, um, your presentation and
how we get there.

How we get you better as well.

Rosie Skene:

Yeah,
they absolutely do. It's, um, yeah, it's a holistic thing, isn't it? With your
mental health. Dr. Shiromi, um, For people, a lot of different people have
different treatments in relation to their mental health. Personally, I've never
been medicated. It wasn't something that I was comfortable in doing because I
was a single mom of 3 kids at the time. My husband was away for more than 12
months.

I know a lot of people worry about being medicated and what
that might look like. Did you want to speak to that a little bit? And, you
know, I personally know not everyone has to be medicated and there are other
options. So I'd love for you to talk about that if you wouldn't mind.

Dr. Shiromi:

Yeah, of
course. So I think that's, let's leave with that.

There are lots of options, right? And the key for us is to keep
you informed, because when you come in to see us to manage your depression,
your anxiety or whatever it is, it's a collaborative approach. Okay. So to
begin with, no one is going to force you to take any medication that you don't
want to take.

But it's always good to be informed about your options. Most of
the time we don't start medication, um, on a first appointment, very, you know,
very, very rarely would we suggest that. And it's almost a ladder approach, I
think, in how we approach, um, mental health, and we spoke about the holistic
model of care before, and that we try and start you off with lifestyle changes
and psychological management, because we know these things work incredibly well
when it comes to improving depression and anxiety, we've got heaps of studies
to back us up.

Uh, in terms of, you know, improvement in diet and exercise and
sleep, and then cognitive behavioral therapy and various psychological
strategies really, you know, helping you get back on track now that I always
have a chat about medication up front with my patients and say that it is an
option because I like them to know that we've got another card up our sleeve in
case.

The psychology or the lifestyle changes isn't working, um, that
they can come in and we can talk to them about starting medication. There is
great evidence for medication as well. I know some patients have been on that
and things have literally turned around in six to eight weeks, which is
incredible. At the end of the day, if you take a tic tac and it makes you feel
better and you're able to function and be happy in relationships and at work
and in life, then take the damn tic tac.

Rosie Skene:

Um,

Dr. Shiromi:

most
certainly from a side effect profile. The side effects can be quite varied.
There are some people that have such negligible side effects. It really doesn't
bother them. Um, most certainly there are people that will experience symptoms
like, um, weight gain or erectile dysfunction or, you know, various other
things.

But I think the other thing to consider is, is what symptoms
were they experiencing from the depression or anxiety to begin with and in
terms of motivation and concentration and fatigue and weight gain and all of
that. So it's a bit of a individualized. scale of pros and cons. You know,
often when we start medication, we're at a point where things are not great and
we get people back on track.

Uh, medication isn't something we start for a short period of
time. It's not a two week, um, you know, course of, of medication. It's
normally for six to 12 months to begin with. And that's because we've got
studies to back up that if we take you off the medication too quickly, that you
can get rebound symptoms down the track.

It's not a sort of medication that you get addicted to by any
means. And you have to remember that if you're getting severe side effects or
you don't like it, we can. Get you off it. It's not something that, you know,
or we can change the medication, but that's a discussion that I have with
absolutely everyone's that they're informed about, um, the pros and the cons.

Your friend might be on a medication and we might put you on a
different medication that might be due to your symptom profile. It might be due
to considerations of you starting a family, or you might be worried about a
particular sort of side effects. So we might choose a different tablet or a
different dose.

So it's not something that can necessarily be compared with
friends and family, but. Come in and just ask questions and get across the
information so you can make an informed choice.

Rosie Skene:

And
that's the most important thing, isn't it? Just having that information, not
guessing and not Dr. Googling too much like we all do, but actually getting in
and talking to someone that knows what they're talking about.

Dr. Shiromi, what are some things that hold people back from
going to see a doctor for the first time for their mental health?

Dr. Shiromi:

Yeah.
Great question. I think stigma is a very big one that we need to address. Um,
so let's start with the idea that my symptoms aren't serious enough. That's a
really big one.

I especially think that's probably, uh, true of your
demographic and listeners who are listening to this and that you've probably
seen some really awful things and some really awful situations. So when you
compare what you're going through to what you've seen, maybe what you're going
through seems, , not justifiable to come in and see a GP.

And that's not the case at all. Like we were talking about
before, we want proaction over reaction. , you guys and the work that you do is
really hard and it can be exposed to a lot of trauma. So that does put you at
increased risk. So my advice there would be, , your symptoms are serious
enough, come in and we can have a chat and, you know, get you on the right
track because if it's impacting your work productivity and your concentration
and your relationships at home and your, you know, relationships with your kids
and you.

Your inner sense of happiness and self, then that's enough.
That's enough. It doesn't need to be the worst case story I've ever heard in my
life. That's enough. Cause if we can get you back on track and, you know,
improve your work situation and home life and make you happy, then that
justifies it. And I can tell you as a GP, I've been a doctor for 15 years and
never have I had someone coming to see me for the.

Their mental health and thought, gosh, that was a waste of
time. It's never, that's never the case. Often the opposite where I think
bugger. I wish this person had come in three years earlier. It sounds like
they're in a really dark place and they've been struggling alone. And there is
so much that we can do to get them on track.

And I just feel a bit upset and sad that we weren't able to
help them come in earlier. So that's one to begin with. ,I think, The opposite
of that as well. , that things have gone too far, ironically enough. So it's
either that my symptoms aren't bad enough or my symptoms are too bad, but
there's nothing you can do about it.

You know, that's often the case for people who are maybe
thinking about suicide or thinking about ending your life, the idea that, ,
there's no hope. , and that's just not the case at all. You know, as a GP I can
most certainly vouch for the fact that we've helped people on, like I said
before. Various sort of levels of depression and anxiety, and most certainly,
it's not uncommon to have people come in and talk about the fact that they've
thought about ending their life or they're maybe even attempted.

And so we can bring you back from that as well. We can change
and turn things around and it may seem hopeless, but it's also important to
recognize that some of the feelings that you're having regarding that.
Hopelessness and guilt and lack of motivation could actually be linked to you
experiencing depression or anxiety as well.

So it just catch 22 awful circle that you can catch yourself
in. So definitely come in.

number three, I think links to the stigma, that whole idea of
you should be able to fix this yourself. , which is that old school thinking
of, you know, just pull your socks up and get on with it. We don't think like
that when it comes to any other medical condition, no one comes in feeling like
they should just.

breathed a bit harder to improve their asthma. Do they, they
come in with their symptoms of asthma and we help them as a, , as a doctor get
better depression and anxiety are medical conditions. I almost wish that there
was a blood test I could do just to justify them being medical conditions that
I could print out and be like, look, your bloods are showing these, but there's
unfortunately not.

But. We really have to reframe the view in which we see
depression and anxiety and bipolar and, you know, post traumatic stress
disorder to recognize that they are medical conditions and that you do need a
professional to get you back on track, uh, on track and help you. Uh, another
one, the guilt. The feeling that you don't deserve to be helped.

Maybe you've, um, you know, done some things or messed up some
relationships and you're just feeling a high level of guilt or blame and feel
like you're just not worthy of help. That's often a common one I hear as well.
And again, that's not the case. And it can be a direct causation from the
medical condition that you are experiencing.

so come in, have a chat to us, you know, things like
psychological interventions can help you improve relationships and get things
back on track. So most certainly that's one to think about. And the last one is
that I think that we can bring up is that one of feeling like maybe you've been
dismissed before.

Or maybe you're worried that you've been, you know, you'll be
judged or you had a negative experience with the health system or with a doctor
or someone else before in them brushing it off. And it does happen and it sucks
that it happens. I, I hate hearing as a clinician that someone's already seen
somebody and they've just been brushed off because it takes so much courage and
guts to come in and to chat to us.

And, you know, I think it's really important that we make time
for people and acknowledge that struggle to come in and acknowledge that
they've been incredibly brave and courageous to come in and talk to us, , and
push aside those feelings of, you know, feeling like a failure or feeling like
they haven't done enough.

No one chooses to have depression or anxiety. I think we have
to acknowledge that, you know, if there was something you could have done to
fix it. You probably would have already done that. And the fact that it's not
getting better is not because you aren't trying hard enough. That's just such a
load of absolute BS.

And, you know, we don't, again, we don't say that with any
other medical conditions. So we really have to, , work as a, as medical bodies
and supporting people. And I think from an individual standpoint, it's really
important to connect with resources and people that, that you click with. You
know, I think everyone that works in your sort of field, Needs to have a great
GP.

And that's easier said than done sometimes, isn't it? You know,
I.

Rosie Skene:

Especially because all the good ones are taken and closed, you can't get in.

Dr. Shiromi:

It's
really hard and I. So hard. Yeah. And I appreciate that. You know, I used to
hear that when I was first out of training and people would say, Oh, you're not
going to go on mat leave or go on holidays.

Are you, it's so hard to find somebody. And I didn't quite get
it. Cause I was working with a lot of amazing GPs until, , I had my little one
and I figured I'd better get a GP now for him and, you know, when you're
younger, sometimes you maybe don't need to see a GP very often. And then life
brings some curveballs and maybe you need to see them for chronic health or
mental health or whatever it is.

And it took me three go's to find a GP that I clicked with, and
I'm a doctor. So, you know, I went, it is interesting in terms of the criteria
that you look at when you're looking for someone, because it's not just about
having the credentials on the wall. It's far more than that. It's a really
unique relationship we have with our patients, because you want to find someone
that you click with and connect with and someone that you think is
comprehensive and is listening to you and isn't judging you, someone who you
can ask questions to.

Um, and challenge. And I love that when my patient, when my
patient, sorry, ask questions about why I'm suggesting that I'm not suggesting
this or, you know, it's really important that you be a part of that care and
that process and that decision making process. And so if you. If you don't have
someone good, then, , I would urge everyone within the next month to suss out,
you know, especially if you're feeling well, that's a great time to go in and
find a great GP

it's so much harder to find someone when you're feeling
vulnerable and have to talk about your mental health with a complete stranger.
But if you, the next time you get a flu shot or the next time you have to go in
for a sick certificate or something small. Just go in and suss somebody out, to
be honest, because within 30 seconds, you're going to know whether or not you
click with this person and then down the track, if you need to have those big
vulnerable conversations, you at least know that the person in front of you is
a good egg, and so you're less likely to hold off going in in the first place.

Rosie Skene:

Yeah,
absolutely. Don't stop with the first one that you don't enjoy being with. And,
you know, I did say before I've been so lucky, I actually, I've moved around a
few times across Australia since being diagnosed and I've had to maintain that
care with GPs. Um, so finding new ones has been a very interesting experience,
but.

In saying that, you know, I had 1 in Adelaide and immediately I
knew that what, you know, going through the New South Wales workers
compensation system is not easy and I could tell straight away that she just
didn't have the skills. Uh, the knowledge, understanding to be able to do that
for me on a longterm basis.

So I found one, you know, and I had practically told the
doctor, um, you know, this is my situation. This is how it is. It wasn't my
first time with a doctor talking about it, but I'm like, are you going to be
able to provide that care for me? Because I need to know, um, and then, and she
was great. She was like, yeah, I actually can do that.

And I'm like, okay, good. And I kept her for four and a half
years, , until we moved again. So it is so important to, , I think know what
you need from your GP, uh, you know, if it's not your first consultation, and
you're sort of trying to work it out, but what, what do you need to support
yourself?

from your GP and, you
know, do you need someone that has a lot of bedside manner or are you happy to
be straight talk to as well, I

Dr. Shiromi:

think
that's a great point. You know, I, um, often my other tips that I will give
friends and family is. Call up reception and have a chat to them and say, hey,
um, you know, I need someone with a more mature nurturing approach.

Um, is there someone that you'd recommend? Cause personality
plays a huge part of it, doesn't it? In terms of how you connect with someone.
I'm someone that's, you know, very upfront, very black and white and
motivating. And, you know, That might work for some people, it might not work
for other people. You might want someone that's a bit older or something a bit
younger, that's someone that speaks a different language or is an advocate
within a special, you know, particular community.

Or, you know, I've got a patient that sees me for anxiety that,
, she knows, he read on my practice profile that I have a Labrador named
Snickers and she saw that. And she was like, Oh, she's a dog, dog person. I
like dog people. And she's a dog walker. And whenever she's feeling a bit
anxious or a bit kind of nervous when we talk, even though she's knowing me for
a long time.

We revert to a quick chat about our pups and it just helps her
relax. And, you know, so I don't care what it is that you need, think about it
and do the research. And whether it be looking at practice profiles or talking
to friends or getting on Facebook communities and asking people or. Calling up
reception or speaking, whatever it is, find someone that you connect with.

I know that's hard, but once you do, it's worth its absolute
weight in gold.

Rosie Skene:

A
hundred percent. I couldn't agree more with that. You know, being able to keep
a GP for an extended period of time is a gift. Like it's, it's such a blessing
to be able to do that.

Dr. Shiromi:

Yeah.
For sure.

Rosie Skene:

Something that you touched on before, like one of the reasons why people don't,
, seek help with a GP is stigma.

And, , I know we briefly touched on that earlier again, but in
relation to first responders and veterans, it is, I reckon. Probably number one
on the list of reasons why they don't seek help. And it's probably the stigma.
It's not only the way that they think people think about them, that they have a
mental health condition, but the fact that, well, it's not a fact they think
that they may not be able to perform their job role.

Um, and you know, as you were saying, , if it's a physical
health condition, , you've broken your arm or a leg, or you've got a bad back,
or you can see, you can see those things and mental health, you can't, that's
not It's, , an invisible injury. And it's something that people really struggle
with and myself again, like something that I struggled with because I couldn't
see it.

and at the start, I
didn't have, , I like to label things. I'm 1 of those people. So 1 of the times
where I felt an incredible weight off my shoulders was where my psychologist
said, yes, you have PTSD. And I'm like. Finally, I have something that I can
now work with because I know what it is and I, and I can start working to make
that better, but that would never have happened if I didn't get out of my own
way a little bit and not give.

To who it's about what anyone else would think about me. Um,
because I know I knew that I needed, I needed some help and I needed to be
better, but I would never have gotten to that stage of diagnosis if I didn't
take that very 1st step and ignore that stigma. And I just know that that's
something that a lot of people struggle with, which is so, so sad.

Dr. Shiromi:

It is
really sad. And I think, you know, it's a really hard step to reach out, but by
golly, the moment you've done it, it's no longer just you. Like you've spread
the load in terms of, okay, now it's you and me sorting this out together.
You've got a health, , a trained health professional on your side to, to get
you better.

which is, so much better than you swing around in circles,
trying to figure out this and do this. And We often do all these little things
by ourselves. And often by the time people come to see me, they've, they've got
the new haircut and they've read the help, help self book and they've gone on
some vegetable diet and done all these things and tried to desperately do
things and are just feeling so overwhelmed and have that drop stomach sort of
sick feeling that this is never going to get better.

But as soon as you get somebody else on board and someone that
knows what they're doing, the problem becomes so much easier to tackle, even
from a. Just that heaviness that you're carrying around point of view.

Rosie Skene:

Yeah,
yeah. I couldn't agree more. Problem shared is a problem halved.

Dr. Shiromi:

Yeah,
for sure.

Rosie Skene:

Dr.
Shiromi, you are the cloud GP and you have a wonderful program. and you, you
just briefly mentioned, your free resource that is on your website and I
implore anyone that is thinking about going to see a GP and might be a little
bit nervous to go and download that, , as soon as you finish listening to this
episode and.

And see those questions that Dr put together for you, but I
would love for you to talk to us about your program because I think it is
something that's needed to be honest with you that time that can be between
seeing a GP and a psychologist. Unfortunately in Australia at the moment can be
extended. So would you love to tell us about your program, please?

Dr. Shiromi:

Absolutely. Thanks so much for the opportunity. So, yeah, so I was sitting in
my GP office and like I said to you before at the start, I love mental health
and my brave patients were coming in and telling me their symptoms. And we were
having a chat and doing the whole consult like we spoke about and done some
bloods and diagnose them with depression or anxiety or whatever it may be.

And then I'd write them a referral to say, Their local
psychologists, and they would go home and call up their psychologist and have
a, I don't know, a six to eight week wait in metropolitan Melbourne to see
someone. And if we are talking rurally, when I've worked out there, it's
months, you know, it could be three months before three to six months before
you're able to see someone.

And that is an absolute. gut punch, because, , like we said,
when people come in to see us, they're at a point of crisis often. They're not
coming in proactively. They're coming in because they're a shell themselves.
And, , relationships is on the rocks and they've been, they're about to lose
their job and all this awful, awful stuff that they want help yesterday.

So having my patients unsupported just felt awful, awful,
awful. So I went off and did extra psychological training and I would give my
patients and, , effectively psychotherapy in the first few weeks until they
could connect with, , somebody. And I realized sitting in a GP desk that I can
only see 20 patients a day.

and I can't see any more
than that.

Rosie Skene:

That's a
lot though.

Dr. Shiromi:

It is a
lot. Um, but from a scalability point of view, all my colleagues were having
the same problem. And not every GP can go off and do psychological training.
And not every GP has a passion for mental health, right? I love mental health.
Um, you know, colleague next door loves, , slicing and dicing and skin cancer
is not my cup of tea.

I can do it, but it doesn't bring me the warm and fuzzies. So
how do we provide this sort of service to everyone? Which made me think about
providing it through an online platform, , self directed learning so that, ,
I'm not asking you any questions. You're not seeing, , there's not a two way
transfer of information.

It's self directed learning. So it's me talking to you on a
screen and self paced. You can do it when you're free. So there are some
government programs out there, but they were really long. They were six to
eight weeks long. And for a lot of patients, when they come in to see you, they
are so overwhelmed and have so much on their plate with work and projects and
life and looking after kids and.

All the stuff we have on our plate that the idea of doing a
long course was just like, there's no way I can fit that in. I'm barely
struggling to, you know, I'm dropping balls when it comes to the important
things in my life, let alone all the other stuff. So we created a program
that's really short, an hour a day for three days.

Effectively,, if you were real keen bean, you could get it done
on a weekend before your family woke up for brunch. Um, so, you know, it's
three, , consults in the first consult, we go through, Stigma, which is what we
spoke about before. And we look at those reasons that hold people back from
seeking help, and we help you reframe them.

Cause the thing is, if we don't get the foundations, right, we
can do all the psychological therapy and lifestyle stuff we want, but if you
think you're not deserving or you're feeling blame, we're going to have, you
know, less, less. You know, not as good outcomes in the long, in the long haul.
So consult one looks at stigma and then we go through the medical workup and we
go through that process of what actually is depression and anxiety?

What are the symptoms? What are the questions your GP is going
to ask you? And what blood tests are they going to order? And what are the
differential diagnoses that we want to rule out? And we go through that because
I know that not everyone has a great experience with a GP when they're going to
see them for depression and anxiety.

And we want to self correct that situation so that you, again,
have great foundations moving forward. Uh, so yeah, we go through stigma, we go
through the medical diagnostic workup and all of that sort of thing. , and we
go through, , myths about medication and we have a big chat about medication.
So you're informed about the pros and the cons and the side effects and
different medications and all that sort of thing.

And then we go through lifestyle interventions, which is one of
my favorite bits. So we go through, , really practical, , advice regarding
diet, exercise, and sleep, nothing crazy like marathon running, if you're not
someone that, doesn't exercise or going on any crazy diets, but the evidence
based stuff in terms of starting a Mediterranean, , you know, a whole foods
diet, Washuku in Japan.

So it's eating stuff that's, you know, not processed and the
evidence behind that. Then in consult two, we do a little degustation menu, if
you will, of psychological strategies and therapies. So we go through problem
solving therapy. Cognitive behavioral therapy and a bit on mindfulness. Again,
we've really focused it on being really practical.

So the stuff that you can implement yourself and there's
downloadable PDFs and resources so that you can think about the problems that
keep you up at night and write them down and have a psychological process for
being able to manage them and manage the worry. Because that's one of the
things that kind of goes out the door sometimes with depression and anxiety is
that executive functioning of, you know, knowing not to stress about something
because you may not have control or knowing to, , only worry about in these
circumstances or having a plan of action.

It can all just feel really muddled and overwhelming. So we go
through some strategies with that and some, some help with mindful breathing
and exercises to help you there. And then in the third consult, we go through,
, social connection, suicide safety. So in social connection, we go through
helping you build social connection.

Cause we know that loneliness is a really big factor when it
comes to mental health and wellbeing and something that we all struggle with in
today's world with Uber Eats and meetings on zoom and not catching up with
people in real life as often as we previously would. We have a big resource
there that I think is one of my parts of this program I'm really proud of,
which goes through tips for family and friends who are helping someone with
depression and anxiety.

It's often something that's overlooked, but you know, it's not
uncommon as a GP to have someone come in with their partner or whoever, and
that partner to sit there going, you know, I've told so and so to do this and
this and this, and I've told them to do that, and they're not doing this, and
they're sleeping in, and they've done this, and we had on.

And you can just see that the dynamic is making the whole
situation 10 times worse. And it's not because the partner is trying to make it
worse. They're coming in with such good intention, but they're also very scared
and completely lost as to how to help this person. So it's a whole resource and
providing, , Practical judgment free support for that person.

And for that particular module, I most certainly encourage
everyone to get family together to watch it and to have those discussions. And
then the last part of that 3rd module is about suicide safety, which is
something I think we need to talk about with everyone. Absolutely everyone,
because if there's one thing I've learned over my years of being a doctor is
that you can't, , judge a book by its cover and that someone, , they might even
not want to tell me about it in the first appointment.

It might only be the 3rd or 4th appointment that they open up
about it, but I think that absolutely everyone. Who struggles with symptoms of
depression or anxiety or struggles with those conditions needs to have a
suicide safety plan in place where we talk about, okay, if you all of a sudden
were to feel those feelings or think about that stuff and actively want to end
your life, what are the steps that you do?

Personalized steps that you do to get yourself out of that
situation, , physically, what do you do? Where do you go? Who do you call? What
resources are there? And so we go through all that sort of stuff. And I hope
that nobody needs it, but by golly, it's important to have, you know, an
umbrella for a rainy day because these things can come up out of the blue.

They might just be, your car might get hit on the way home from
work. And that's just the, , the thing that broke the camel's back. And so
having that, Plan in place and having discussed it with family and friends from
the very start, even when you weren't that, , unwell, leads to a situation
where we're just creating a safer community.

So yeah, that's kind of a debrief on the, on the program. It's
like I said, it's short, it's, , you go online, you don't need a referral. You
don't need a GP to refer you to it or a psychologist. You can just go on and
sign up and then start the program. And, , Yeah, it's most certainly for people
that have seen a GP and are waiting to see a psychologist, but most certainly
we've had a few people do it who are yet to see a GP as well, that just are
feeling really apprehensive, , about that step and need kind of a stepping
stone resource to build the confidence that they need.

And the knowledge to be able to be comfortable going to see a
GP. So yeah, hopefully it helps people out there.

Rosie Skene:

I would
have been one of those people if it was around a hundred percent, cause I love
researching everything and finding out everything. But I think also too, with
that resource, , they can use the information, , when they make their own notes
and they come up with their own plans and take that with them to the psychology
appointment as well.

Right.

Dr. Shiromi:

For
sure. I mean, that's the benefit of this program is we're actually expediting
care so we can get the foundations right and we can get you learning and
understanding about different psychological strategies and get you doing some
things before you even start by the time you hit the psychologist's office
after you've had your X number of weeks wait that you didn't have a choice
over.

You are ready to hit the ground running. , that's like the
psychologists often report. They don't need to go through the basics of people.
They've got a really good understanding of their condition. They have a really
good understanding of the fact that we have to take a holistic approach to
mental health and wellbeing so that we need to do the lifestyle stuff and deal
with the toxic boss and deal with all of these other things while doing the
individualized psychological therapy.

And they've got realistic expectations as well. Cause let's be
honest, when you see the psychologist for the first time, it's not like they
sprinkle fairy dust on you and you magically get better as much as that's what
we're often hoping for. The first few appointments are often history taking,
you know, they're, they're asking questions about Your life and about your
childhood.

And I've had patients who have come back to see me after being
referred by another GP who have dropped off because they got frustrated that
the psychologist was asking about their parents divorce when they wanted to fix
things with their fiance and their work situation. And we've had to go back and
go, Oh, hold on.

Let's just explain how cognitive behavioral therapy works. And
the fact that. Yeah. You know, the way that you were raised and your
experiences frame the way you view the world. And that's probably what the
psychologist was trying to, to figure out and help them understand the therapy
that they were having.

Cause if you don't understand the therapy that you're having
and had those insights again, there's a chance of disengagement. So it's really
our job as GPs to prep people for the best possible outcomes when they're going
to see the psychologist. The truth of the matter is, is that now with, you
know, reduction in resources and all that sort of thing, and cost of living
people are definitely coming in with a shopping list of things to sort out with
the GP, is that it's becoming a very reactionary medicine where we're just
like, right, what's wrong?

Oh, you've got a cold. All right, let's sort that out. What's
your elbow pain, migraine, you know, and where we don't talk about the, the
other stuff, the lifestyle stuff and the preventative health stuff. But, , the
evidence suggests that that's the stuff we really need to get onto if we want
to make you well.

So yeah, most certainly that's something with the program. It
gets the ball rolling. Um, it gets, and often patients will start to feel
better before they even start to see the psychologist, which is amazing.

Rosie Skene:

Yeah.
And just even with that, with the psychologists and people becoming disengaged,
you know, something that I didn't really.

Realize that would happen with me. I was exhausted. Far out.
Yeah. I was so exhausted. And a friend of mine, , after, , I've been taking my
psych for a couple of years, she sent me a message and said, I'm sitting
outside of a psychologist's office. I'm waiting to go in and , I like great.

Like, this is great for you. Mm-hmm. And then afterwards she's
like. I'm exhausted. And I'm like, Oh yes, I did forget about that. It is so
exhausting the first few times because it's a lot, right?

Dr. Shiromi:

Very
much. And also we are dredging up and digging up some really painful often
memories and trauma. And there's no like light skirting when you're doing one
to one therapy, it's deep, deep stuff.

And you can come out feeling tired and exhausted. I mean,
sometimes you come out feeling relieved and like, there's a burden that's
lifted off your shoulders. So people have varied expectations, but. You know,
it's nice to have the heads up on those experiences before you go in. Cause if,
yeah, if someone doesn't know that that's normal to feel that way, and it does
take a few appointments to start the ball rolling.

Um, they can walk out after the first appointment and just be
like, Oh no, thank you.

Totally. So that's, you know, that's just the unfortunate
nature of GP now. And, , They're maybe not having the time to go through and
explain all of that. But if we can explain people to people that the process
and what we're doing and how it all works, you're more likely to engage. It's
the same as taking a tablet.

You know, I can give someone a cholesterol tablet and just say,
here's a tablet, take it, your numbers of this. Or I can sit down and go, look
here, your numbers from your cholesterol result, and this is what they're meant
to be. And here's the the range of what you are and then draw them a picture of
their blood vessel and show them the, you know, the blocked artery and be like,
this is what this medication does.

And this is how it works. And, , we're hoping to get you to
this number. I'm going to give you a pathology slip and we're going to recheck
it in three months time and explain that whole process. And what it means is in
the morning, , when you have to take that tablet. You get why I'm asking you to
take it as opposed to being like, nah, I can't be bothered.

You now are informed. You're a part of the process. So that
happens with every other, every aspect of medicine. We know that informed,
engaged patients have better health outcomes. So that's what our program is all
about. It's helping you become informed and engaged about your own health and
helping you get those wins so you can enjoy life.

Rosie Skene:

Yeah,
absolutely. I'm so, you know, you did mention suicide and, and that's part of
your program to talk about that and, and get a plan together if you do have
those thoughts and feelings, and unfortunately, you know, nine people in
Australia every week commit suicide. So it's a very real risk for people in our
country at the moment, but you also touched on the cost of mental health, um,
and seeking help.

Seeing a doctor, seeing a psychologist, uh, is it still the
case that you can go on a mental health care plan and you get a certain number
of visits for free or a lower cost? Is that something that's available to
people?

Dr. Shiromi:

That's a
really, um, good and topical point of discussion. So yes, at the moment you can
still see a GP and, uh, as long as you meet criteria for being diagnosed with a
mental health condition.

And so you meet the symptoms and the timeframes and all that
sort of stuff. You can get access to subsidized psychology sessions. So it's,
you get. 10 subsidized psychology sessions. You don't get them all at once. I
think you get, , either, you know, six to begin with, and then you go in for
review and then you get the other four.

That may be changing with the federal government budget
changes. Which is just heartbreaking. , you will see what happens come
November, but they're looking at categorizing the severity of people's
illnesses and only being able to provide that service for people with a certain
level of mental health.

on top of already having a diagnosis, which I understand from a
resource allocation point of view, but from a medical doctor point of view, it
is the worst thing ever because now we're effectively waiting for people to get
worse before we're going to give them help. You know, a terrible way of
thinking when it comes to healthcare, , an assistant, we need to create
proaction and change early on to help people from not getting to that, , care
where they end up in hospital, even point of view, when someone's in hospital
after having a suicide attempt or being really unwell, that costs money.

, and it's, , far less to fund early intervention. Uh, I think
that the government is going to start. , helping people with more online
resources, which is a good thing. , but hopefully they find a way to be able to
subsidize the program for everybody, because the last thing we want is people
getting unwell.

The fact of the matter is, is that we need to do things. The
moment people come in asking for help is the moment we need to help them.
Right. And like we said before, often when people come in, they're not coming
in early. They're coming in later. So the chances are that most people in that
situation will probably still qualify anyway, to be honest, because I can't
think of anyone that I've referred to a psychologist that I would say, Oh no,
they didn't need to see the psychologist costs money.

I mean, it's, , seeing a psychologist and sometimes I've had
patients, , and I've had patients go through our program, our online program,
because they're getting the funds together to be able to afford to see the
psychologist, even though there is a subsidy. , so my key point there would be
to try and take action ASAP when it comes to your mental health and wellbeing.

And when we talk about cost and finances, yeah, it's expensive
to see a psychologist and it's expensive to see a GP, but we also need to
consider the expense of not something we sometimes overlook the cost of, you
know, having reduced concentration, low work productivity, the cost of sick
days, the cost of lost unemployment or reduced job opportunity.

That also is a cost that can impact you. So even from a
financial point of view, it does make sense to get on board and get this stuff
sorted before it gets bad.

Rosie Skene:

Yeah.
Yeah. At that first little niggle, and you think that something might not be
quite right, go and see someone.

Dr. Shiromi:

For
sure.

Rosie Skene:

Yeah.
Thank you so much, Dr.

Shiromi. This has been a really wonderful conversation and one
that I've wanted to have with someone for a long time. The reason I started the
podcast Was because I, I got sick of seeing another police officer, another
veteran committing suicide. Um, it's a crazy time and there's not enough that's
being done proactively, , to one normalize, , mental health , and in our work,
these workplaces especially, and to reduce the stigma and to provide
information and what you said before is like, you know.

You almost have to get worse to get help to get better. And I
have certainly seen that in those industries and it's not great. So I'm so
grateful that you could come on and encourage people on that, at that very
first little niggle, that something might not be quite right. So please go and
seek the help.

Go to your website, the cloud GP, download that free resource
or join your course and, , take part in that and get all the help that you need
because everyone is so worth it, every life matters. And, and I'm so grateful
that you could come here today.

Dr. Shiromi:

My
pleasure. Thank you so much for having me.

Rosie Skene:

I hope
you've enjoyed today's episode. If you have, make sure to hit subscribe so you
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Your support means the world. My name is Rosie Skene join me
again next week for another empowering and positive episode of Triumph Beyond
Trauma. Until then, be kind to your mind and trust in the magic of your
consistent and positive efforts. Triumph Beyond your trauma is closer than you
think. Have the best week.