http://en.wikipedia.org/wiki/Charles_Teo
MONICA ATTARD: Dr Charlie Teo is the brain surgeon that many Australian and international cancer patients turn to when other surgeons say they have an inoperable tumour.
But it's not just his pioneering use of neuroendoscopy that sets him apart from his colleagues.
Hello, I'm Monica Attard and Dr Teo joins us today on Sunday Profile.
Charlie Teo hit the headlines not long ago after the New South Wales Cancer Council gave winners of a charity auction a chance to spend a day with Charlie.
The criticism which followed was prompted by a report written by Sydney University's Dr Simon Chapman for the British Medical Journal called: Should the spectacle of surgery be sold to the highest bidder?
Well that's a reasonable question and it's caused quite a barney.
In the midst of it all Dr Teo was awarded an Order of Australia. But he says he's used to being isolated and maligned by his neurological colleagues.
CHARLIE TEO: When I first returned from America a mentor said to me it's going to take about five years for you to be accepted by your peers when you move to another place.
And after five years it really hasn't changed much. I still get nasty letters from colleagues. And a lot of patients still tell me about nasty comments they make about me; very malicious comments and untruths.
MONICA ATTARD: Things like what? What do they say to you when they write to you?
CHARLIE TEO: Oh terrible things. Like I operated on this lady with a malignant tumour. I bought her about eight months of life.
And the doctor that she'd been seeing before said that said that she was inoperable wrote a letter to all the referring doctors, 17 people in total, saying that what Dr Teo has done is tantamount to malpractice, you know offering people hope like this is wrong. This lady had a malignant tumour. There's no evidence in the literature to support what he did.
Others have told patients that I over-charge, that I failed my exams, this and that. And you know that I'm manic depressive psychotic. There's just so much out there that's so untrue. And it keeps coming.
MONICA ATTARD: And is the basis of that sort of criticism, that extending somebody's life by eight months is seen by some to be not worth going through the surgery?
CHARLIE TEO: Look there are two sides to every story. And I although disagree with one side to the story I understand what they're saying.
So what they're saying is look, the health dollar is very precious. We have to rationalise services.
And when someone has such a bad condition as brain cancer, we know they're going to die and they're usually going to die within 12 months of diagnosis. They cost a lot of money to keep the patient alive for that period of time. Is it really worth it?
So I understand that side of the argument.
MONICA ATTARD: But you don't accept it.
CHARLIE TEO: But I don't accept it, no, especially in the private patient who's willing to pay the money themselves.
Sure the government pays some of that money. Medicare does cover some of their costs so the taxpayer is paying for some of that.
But life to me is just so precious Monica. I fail to see the wrong in keeping someone alive who's still got quality of life even if it's only for a few months.
MONICA ATTARD: And the other claims that you get about over-charging, having failed exams - what's the basis of that?
CHARLIE TEO: It's professional jealousy because they're unfounded most of the things they say.
You know they can say over-charge because I do charge a gap. But I certainly don't charge as much as much as most neurosurgeons charge. And I certainly don't make as much money as my other neurosurgical colleagues who do spine surgery for example.
Failed my exams - absolutely I failed my exam once. But you know they claim that I failed them several times.
And the list goes on and on. So I think most of it is just professional jealousy and they have to make up something because they have to try and topple me some way.
MONICA ATTARD: And is the professional jealousy do you think borne of the developments that you've made in the field? Or is it because, is it more a personal thing? Is it more of your flamboyance, your high profile, your being out there?
CHARLIE TEO: No I think it's the latter. It can't just be from the advances I've made because there is that BTA - been to America syndrome where you know, oh don't think you're any better than us just because you've been to America.
But that usually only lasts for a few years and then they realise you're doing good work and they embrace it because most doctors are in the game for the right reason; that is caring for patients.
So I'm sure that if it wasn't for the other side, ie my flamboyance, my media profile etc, etc then it wouldn't be as vicious or malicious as it is.
MONICA ATTARD: Dr Teo let's talk about this issue that has arisen - the Cancer Council of New South Wales offering a spend the day with Charlie prize.
This has happened before as you've pointed. It has occurred at least four times. Why do you think that the argument arose this time and so furiously and not on previous occasions?
CHARLIE TEO: That's a pretty loaded question - because it came one day after I got the award. (Laughs)
But look I have been doing it for many years. I haven't been doing it under the radar. It's been offered at high profile functions like the Posh Ball run by the Cancer Council.
Other surgeons do it. At my hospital there are three or four other surgeons that have offered a day with them. So no it's not something that it foreign to the college or to my colleagues.
And like I say I've never hidden it's. It's not something that I'm not proud of. I'm very proud of it actually. Nothing but positive things have come from it.
So it just seems awfully coincidental that it came one day after the Australian awards.
MONICA ATTARD: Well clearly you don't think it's coincidental.
CHARLIE TEO: No I don't think it's coincidental. But you know I don't know but it seems awfully coincidental to me.
MONICA ATTARD: Okay now I know that you've said that you don't have any concerns with it. But there are some people who do and they are eminent. So let's just go through...
CHARLIE TEO: Yeah absolutely.
MONICA ATTARD: ..some of those arguments if you don't mind.
I mean the Royal Australasian College of Surgeons says non-medical people should not be allowed into surgery. The college wants to talk about what's been happening with you.
What are you expecting when those talks occur?
CHARLIE TEO: If I could take one step back - in the olden days yes, they used to let the public in to watch from balconies.
They realised then that they were selling themselves short or things were happening that they didn't want the public to know so they banned the public. And they put themselves in a bit of an ivory tower where they hid a lot of what was going on behind closed doors.
And then along came audio-visual advances and filming of surgery etc, etc for teaching purposes. And then that of course disseminated to the public, rightly or wrongly.
And then the public started realising that in fact it was not only very interesting but also very educational. And it broke down some of those barriers that were hitherto constructed.
I think in fact that the olden days have done, we've done the full circle; that the public are now being invited in rightly or wrongly into the operating room. I think rightly. Other people think wrongly. And that's something that we have to actually accept because there's nothing we can do about it.
MONICA ATTARD: But why? Why do you think we should accept it?
CHARLIE TEO: We can't stop it. It's on Youtube. If you Youtube craniotomy you can see craniotomies on Youtube. So it's there.
If you Youtube rhinoplasty, Youtube any sort of medical condition you can see a video.
Yeah I'm sure a lot of it has been approved and consented properly. It's then been shown at say some scientific forum. And then someone has taken it from that scientific forum and disseminated to the public. So it's there.
You can go to websites. Anyone can go to a website right now and see an operation. So you can say rhinologyarchives.com and there's surgeons from all around the world showing their operations. You don't need a password to get in.
The second thing is what are we trying to hide by not letting the public see it? Yes we certainly want to try and hide the person's identity and that has been done thankfully.
All those Youtube clips you don't know who's being operated on. And certainly when I show videos you don't know who's being operated on.
So patients' anonymity should be kept precious. That's the first thing.
The second thing is are we trying to hide the actual surgical technique or what goes on in the operating room? And in the olden days, yes maybe they did try and hide the mistakes.
But I don't think you should do that. I think it's legitimate to not only show the successes but also the failures. And then that would again I think would only add to the public's knowledge of what goes on behind closed doors.
MONICA ATTARD: Okay now the anonymity of the patient is a really interesting point and I want to get to that.
But before we do can I ask you, Dr Simon Chapman who has raised a lot of these issues, these ethical issues in a paper that he's published, and the College of Surgeons have raised these issues.
They're concerned about a patient feeling under pressure to agree to having an observer in the room because they want to please you; that even though you're not involved in the asking, that members of your staff do the negotiating with the patient, that there might be an unfair sense of obligation that's easily exploited.
Is that of concern to you?
CHARLIE TEO: Yeah. It was a concern even before this issue was raised publicly, so much so that I've tried to circumvent that by a certain protocol in our office.
For example I would never ask the patient. I think that does...
MONICA ATTARD: Does it make a difference whether you're asking or your staff are asking?
CHARLIE TEO: Oh I think so, absolutely because you know it's a very objective, official sort of situation outside in the office.
They get four consent to sign.
They sign an informed consent about the operation. They sign a consent about financial consent, about paying the gap. They sign a consent about their tissue being taken and put in a bank.
And they sign a consent about photos being taken and the public being allowed to watch the surgery.
And then they take them home. They can discuss them with their families. They don't have to sign them on the spot.
So yeah, no I think it's a very objective way of doing it. I think it does take away that emotional coercion that may be associated with it. And I've been cognisant of it right from the start.
And furthermore it's been reinforced to me that they do have a say and they can reject me because patients do reject it. And that's not uncommon.
I mean it doesn't happen that often but at least once a month a patient would say, actually no, they won't tick that box. I feel good about that.
MONICA ATTARD: Would you imagine then with a patient who for example was not particularly say educated, who comes to you for help and you agree to do the operation. You ask them for their consent to have observers in the room.
They're desperate for your help. They're desperate to please you because you're the person who is going to save their life hopefully or preserve their life for a little longer.
Is that informed consent?
CHARLIE TEO: I think it's informed if they ask you further questions. And people have done that.
For example if you just sign a form and you don't really know what's going on - what does this mean? Are you just going to take pictures with a camera or what? So they ask you know, what does this mean? Who's going to be in the room? And I'll tell them.
Well hang on doctor, is it going to affect your performance? Are you going to be nervous for example?
So yeah, then you have to explain to them what it's all about. And again I think that's good.
I think this whole debate's been good actually. You'll hear that I've never been critical of Simon Chapman. I know he's critical of me.
But the whole issue does need to be raised because I am sure, I hate to say it but I'm sure there are people out there who do have hidden agendas and who do sort of emotionally coerce patients.
I know of one personal example. When I first came back I was on Channel Nine and the producer said that a surgeon, neurosurgeon went to her and said, "Can you film this operation? It's breaking ground. It's very good."
So they went to film it. He was very nervous, clearly nervous. Patient did very poorly, had a bad complication in the operating room.
MONICA ATTARD: Did you report that incident?
CHARLIE TEO: No I didn't report that incident no.
MONICA ATTARD: Is that not something that you would feel an obligation to report to the Royal college?
CHARLIE TEO: There's a lot of things that have happened to me that I probably should have reported to the college.
MONICA ATTARD: No but that incident where a patient suffered?
CHARLIE TEO: Yeah, no, no there are instances as well Monica where patients have suffered at the hands of my colleagues, a lot of cases. But I haven't reported them.
MONICA ATTARD: And why not Dr Teo?
CHARLIE TEO: Look I know the workings of the college. I know that they gun for people like me but they don't gun for other people. I know that there's a game that you have to play. I know that there is a boy's club that you have to be part of.
And I know that if I spend a lot of time and effort and I would have to, not only emotional time and effort but real time and effort to report to all these cases, I know that they'd end up with a very negative outcome for me.
In other words you know it'd probably be washed under the carpet.
Again I'll give you an example. A patient died that I knew about. It turned out that her relative was a doctor at the hospital that I worked at. He asked me to investigate it.
I wrote a written report, put a lot of time and effort into it, asking for it to be investigated. And I was told very clearly that everything that could have been done was done properly.
So I know that I put a lot of time and effort into that and it came to nothing except a lot of angst for me and a lot of time and emotional turmoil for me.
MONICA ATTARD: And that is because of your standing within the professional community?
CHARLIE TEO: Partly my standing I guess. But again unfortunately doctors are the worst, their worst peer reviewers.
MONICA ATTARD: And they don't like to be judged.
CHARLIE TEO: No, no. I mean why do you think lawyers have made such a living out of medical malpractice suits? Because doctors don't do it well.
That's a statement I'm happy to make because it's made, been made publicly before. We are very bad at reviewing ourselves.
So when someone like me who is truthful to a fault goes to the effort of complaining about one of their colleagues and finds that all that happens to them is they get a slap on the wrist and you get back into your hole Charlie type of attitude, then after a while you just don't do it any more.
MONICA ATTARD: Before we move on to some of the other ethical issues, amongst them privacy which you're already raised, I want to ask you because you do perform surgery abroad a lot, do you find the same standards of jealousy and unwillingness to be criticised in some of the hospitals in which you perform abroad?
CHARLIE TEO: No. Of course not, no.
MONICA ATTARD: So it's an Australian phenomenon?
CHARLIE TEO: Well they may, well you can't be a prophet in your own land. So there may be a Swedish neurosurgeon that gets treated the same way in Sweden as I get in Australia.
But when I was in Sweden last week, oh no, all the neurosurgeons at the Karolinska Institute came to watch. They took me out to dinner. They congratulated me on the great result. They absorbed the information that I taught them like sponges. The local TV stations wanted to film me because the girl had this terrible tumour that I managed to take out.
No, I was lauded like a prophet in that land.
MONICA ATTARD: Do you see yourself as a prophet in a medical sense?
CHARLIE TEO: In a medical sense yes. But I'm not unique. I mean (laughs) there are many prophets in many different vocations.
I happen to be one of the, well you know without sounding too egotistical I am a pioneer. I am doing pioneering stuff in neurosurgery. There is stuff that I'm doing that no-one else is doing or else I wouldn't be invited to Sweden and America and Pakistan and Germany to operate you know.
MONICA ATTARD: Okay let's just go back to the issues then. There's also the issue of privacy when you allow observers in to see your surgery because I imagine the temptation if you were the lucky auction winner to tell the tale at a dinner party and as has been brought up before by Dr Chapman would be quite big.
I mean what if you have a very famous actor on your operating table? Does the observer or the observers know who you're operating on?
CHARLIE TEO: That's never arisen. Well it has arisen of course with Aaron McMillan the quite famous pianist on whom I operated but he requested media coverage.
But no, if I operated on a high profile patient as I have many times I would certainly give them the same option to reject any sort of audience and to remain anonymous, absolutely, yeah.
I've operated on VIPs from America here in Australia and they have wanted to remain anonymous. And we've called them even a different name and the hospital have provisions to call them a different name.
MONICA ATTARD: Do you run checks on who will be in theatre looking on?
CHARLIE TEO: Only in that I meet them. And I feel that I have a good enough social radar to tell good people from bad people.
MONICA ATTARD: Now Dr Chapman has also raised the issue of other doctors or nurses in the theatre feeling self-conscious.
Now the sort of surgery that you do is intricate. I imagine that every millimetre counts.
CHARLIE TEO: Oh yes.
MONICA ATTARD: Are you concerned about the distraction element?
CHARLIE TEO: Oh absolutely. I think some doctors don't perform under pressure. And I think some staff don't work well under pressure.
So I make sure that my staff are very comfortable. You know I've got a bad reputation for being quite callous when it comes to culling staff. So my staff in my operating room, they've been with me for many years. They are selected personally by me.
If I ever felt that one of them felt uncomfortable with an observer in the room, then not only would they feel comfortable to tell me because I socialise with all my staff and they know me well and I consider them friends and we travel overseas together.
But I would also expect that they would approach me and say, look this is not right, or you know you shouldn't be doing that, or I feel uncomfortable. We have a good enough relationship where they can tell me that.
MONICA ATTARD: And has it ever happened that any of your staff or indeed yourself have been distracted by you know what's happening in the observer gallery?
CHARLIE TEO: Never. There was one incident - so I've never had a staff a say I'm distracted by this person or that person or you know you're doing the wrong thing or don't do that or I don't feel comfortable with this.
One of my staff felt comfortable enough to tell me she was uncomfortable with me. What happened was that the observers wanted a photo with me in the operating room and I said, "That's fine." The patient was in the background. And she thought that that was inappropriate so we changed that.
That reinforces to me that my staff feel comfortable enough with me to tell me that they are not comfortable with a certain situation.
MONICA ATTARD: It's an issue of course that has been debated both within the medical profession and outside of the profession. Do you think the general public has a right to a voice in this debate? Or is it essentially do you think a medical ethics question which only the profession is qualified to discuss?
CHARLIE TEO: That's such a good question but I can't answer that. This is what I'll say: I think it all boils down to the doctor. I think if the doctor is a good doctor and has a patient's best interest in mind then he's not going to allow anything to compromise that patient's care.
So the media can say what they like. The hospital can bring in any jurisdiction they like. They can allow this or disallow that.
The bottom line is the doctor has to care for his patient. You have to have that overwhelming sense of welfare for your patient.
And I hate to say it but there are some people who don't and that's why people have to come into the debate. And that's why jurisdiction has to be laid down. And that's why rules have to be made - because some doctors I'm sure have a hidden agenda.
Now most doctors don't. Most doctors are in the game for the right reason. But unfortunately there are a few that give us all a bad name.
I would like someone like Simon Chapman or the public to come and see the way I interact with my patients and see that I care for them more than anything in the world.
And I have a completely different relationship with my patients. I've been criticised for it…
MONICA ATTARD: You have indeed I mean…
CHARLIE TEO: I take them home to dinner. They stay at my home. I call them friends. I go to their weddings. They name their children after me. It's a completely different relationship that I have than most doctors have with their patients.
It's that that gives me not license so much but gives me at least justification to do what I do.
You know they know that it's all very positive. When these people observe surgery what do they go away with? They go away with inspiration.
Some of them go away with thinking, oh my God I'm never going to do medicine like I thought I would. Some of them go away thinking, oh, brain cancer is such a terrible disease, I want to do something about it.
MONICA ATTARD: But I guess the issue is not so much the positives. The issue is in an ethical sense whether it's actually worth it given the downside, given the privacy issues, given the issues of consent, informed consent and coercion.
So in your mind is it all worth it?
CHARLIE TEO: Yes, yes it is.
MONICA ATTARD: Because of the money that's raised?
CHARLIE TEO: Yes because of the money that's raised, because of the education of the public, the inspiration it provides to some people. Yes I think it's worth it.
We have had patients in the operating room that have been supporters of the Cure For Life Foundation, the brain cancer foundation that I started. And they have been so inspired by what they see that they have then donated money. And not only that, they've raised money through balls and dinners and functions.
And so there's this add-on effect, this multiplying effect where if you inspire one person then that person will then go out and be an advocate and an ambassador for your cause and generate money.
MONICA ATTARD: There are many doctors who argue that there are other ways to fundraise from the public but in terms of what you do that what ought to be happening is that you should be leaning on other doctors, who are let's face it generally speaking quite wealthy, to be able to contribute.
CHARLIE TEO: (Laughs) Okay yeah, okay well no…
MONICA ATTARD: Are they not generous in…
CHARLIE TEO: I will make a statement there. I think, yes I've been very upset and disappointed with the contribution from my colleagues for the Cure For Life Foundation for example.
My colleagues operate on brain cancer patients like I do. They must see the misery and the suffering. And yet they don't contribute to the Cure For Life Foundation.
MONICA ATTARD: Is that because of you?
CHARLIE TEO: Yes unfortunately (laughs). Well, yeah, well I don't mind if they start their own foundation and raise money through something else but they don't even do that.
MONICA ATTARD: Dr Teo what happens if the college finds that you've breached one or more of its codes? Would you fight that?
CHARLIE TEO: Oh yeah, I'd fight it tooth and nail. In mean if I've done the wrong thing in terms of broken a set law yeah absolutely. But if it's some fuzzy sort of ethical issue that they're concerned about, yeah I'd make sure I'd fight it because I know that I haven't done anything wrong.
And you're right Monica. There must be one patient out of the thousands I've operated on that felt a little bit uncomfortable about it but didn't say anything. I would certainly take that and try and work with it and make sure it doesn't happen again.
But it's never happened.
MONICA ATTARD: And would it be reasonable if the college pointed to that one particular case and said but even one case is enough to warrant stopping this practice?
CHARLIE TEO: Again I'd have to say yes. In other words if I've operated on 8,000 brain tumours, if 7,999 patients were satisfied, if I'd done the right thing, if I have funded research like I have, if I've raised millions of dollars like I have, and yet there was one patient out there who was unhappy, I think it's a price that you pay. The good would overcome that one bit of bad.
MONICA ATTARD: Dr Teo given all that you've said about your colleagues in this interview, most of which has been quite disparaging, I do wonder why somebody of your stature in the international medical community, why you stay in Australia.
CHARLIE TEO: Well from a professional viewpoint I haven't quite stayed in Australia because as you know I go to America once a month. And I work overseas and I'm a consultant for a German company who really look after me well and listen to what I have to say and develop instruments for me.
So in many ways professionally I have not completely cut my international ties.
From a social viewpoint there's no better country to live in than Australia. And I love Australians.
Look I have been mostly disparaging to a very vocal and malicious percentage of neurosurgeons. But overall doctors have been very supportive. General surgeons for example after this last issue have come out really supporting me.
MONICA ATTARD: So do you feel very isolated?
CHARLIE TEO: Yes. I've felt isolated ever since I came back. And again it wasn't unexpected. I expected that.
There was a time about three years after I came back that I was offered a great job in New York and I came home and spoke to Genevieve and I said, "I can't put up with this any longer. I'm all by myself and I feel very vulnerable and I want to go back to America." And she supported me.
It wasn't until I went paddling on Sydney Harbour in my kayak at 5.30 in the morning and saw how beautiful Australia was that I realised I was doing the wrong thing and I wanted to stay here from a lifestyle viewpoint.
MONICA ATTARD: Dr Teo, a final question if I might. We now have a new health package. Is this something that you see as a positive move towards fixing up what most say is an ailing health system?
CHARLIE TEO: Absolutely. I'm very impressed.
Essentially I think the health system has been ailing. There's been inherent problems in it that I think that are unfixable. And I think this new health package is addressing a lot of those issues.
If you run a hospital on a budget then of course the worst thing you can do is have a full hospital because you go over budget, you get penalised for it.
So it encourages almost poor quality of care. If you provide a great service, patients come in, you go over budget. So of course there was inherent problems with our health system.
Activity based funding is something that the federal and state governments have identified as a way of trying to overcome that. And they're both bringing that into the new packages.
I think it's a fantastic advance in the way we look at health and the way we run our health system.
MONICA ATTARD: That was brain surgeon Dr Charlie Teo ending Sunday Profile this weekend.
Thanks for joining me, Monica Attard. And thanks to our producer Belinda Sommer.
MONICA ATTARD: Dr Charlie Teo is the brain surgeon that many Australian and international cancer patients turn to when other surgeons say they have an inoperable tumour.
But it's not just his pioneering use of neuroendoscopy that sets him apart from his colleagues.
Hello, I'm Monica Attard and Dr Teo joins us today on Sunday Profile.
Charlie Teo hit the headlines not long ago after the New South Wales Cancer Council gave winners of a charity auction a chance to spend a day with Charlie.
The criticism which followed was prompted by a report written by Sydney University's Dr Simon Chapman for the British Medical Journal called: Should the spectacle of surgery be sold to the highest bidder?
Well that's a reasonable question and it's caused quite a barney.
In the midst of it all Dr Teo was awarded an Order of Australia. But he says he's used to being isolated and maligned by his neurological colleagues.
CHARLIE TEO: When I first returned from America a mentor said to me it's going to take about five years for you to be accepted by your peers when you move to another place.
And after five years it really hasn't changed much. I still get nasty letters from colleagues. And a lot of patients still tell me about nasty comments they make about me; very malicious comments and untruths.
MONICA ATTARD: Things like what? What do they say to you when they write to you?
CHARLIE TEO: Oh terrible things. Like I operated on this lady with a malignant tumour. I bought her about eight months of life.
And the doctor that she'd been seeing before said that said that she was inoperable wrote a letter to all the referring doctors, 17 people in total, saying that what Dr Teo has done is tantamount to malpractice, you know offering people hope like this is wrong. This lady had a malignant tumour. There's no evidence in the literature to support what he did.
Others have told patients that I over-charge, that I failed my exams, this and that. And you know that I'm manic depressive psychotic. There's just so much out there that's so untrue. And it keeps coming.
MONICA ATTARD: And is the basis of that sort of criticism, that extending somebody's life by eight months is seen by some to be not worth going through the surgery?
CHARLIE TEO: Look there are two sides to every story. And I although disagree with one side to the story I understand what they're saying.
So what they're saying is look, the health dollar is very precious. We have to rationalise services.
And when someone has such a bad condition as brain cancer, we know they're going to die and they're usually going to die within 12 months of diagnosis. They cost a lot of money to keep the patient alive for that period of time. Is it really worth it?
So I understand that side of the argument.
MONICA ATTARD: But you don't accept it.
CHARLIE TEO: But I don't accept it, no, especially in the private patient who's willing to pay the money themselves.
Sure the government pays some of that money. Medicare does cover some of their costs so the taxpayer is paying for some of that.
But life to me is just so precious Monica. I fail to see the wrong in keeping someone alive who's still got quality of life even if it's only for a few months.
MONICA ATTARD: And the other claims that you get about over-charging, having failed exams - what's the basis of that?
CHARLIE TEO: It's professional jealousy because they're unfounded most of the things they say.
You know they can say over-charge because I do charge a gap. But I certainly don't charge as much as much as most neurosurgeons charge. And I certainly don't make as much money as my other neurosurgical colleagues who do spine surgery for example.
Failed my exams - absolutely I failed my exam once. But you know they claim that I failed them several times.
And the list goes on and on. So I think most of it is just professional jealousy and they have to make up something because they have to try and topple me some way.
MONICA ATTARD: And is the professional jealousy do you think borne of the developments that you've made in the field? Or is it because, is it more a personal thing? Is it more of your flamboyance, your high profile, your being out there?
CHARLIE TEO: No I think it's the latter. It can't just be from the advances I've made because there is that BTA - been to America syndrome where you know, oh don't think you're any better than us just because you've been to America.
But that usually only lasts for a few years and then they realise you're doing good work and they embrace it because most doctors are in the game for the right reason; that is caring for patients.
So I'm sure that if it wasn't for the other side, ie my flamboyance, my media profile etc, etc then it wouldn't be as vicious or malicious as it is.
MONICA ATTARD: Dr Teo let's talk about this issue that has arisen - the Cancer Council of New South Wales offering a spend the day with Charlie prize.
This has happened before as you've pointed. It has occurred at least four times. Why do you think that the argument arose this time and so furiously and not on previous occasions?
CHARLIE TEO: That's a pretty loaded question - because it came one day after I got the award. (Laughs)
But look I have been doing it for many years. I haven't been doing it under the radar. It's been offered at high profile functions like the Posh Ball run by the Cancer Council.
Other surgeons do it. At my hospital there are three or four other surgeons that have offered a day with them. So no it's not something that it foreign to the college or to my colleagues.
And like I say I've never hidden it's. It's not something that I'm not proud of. I'm very proud of it actually. Nothing but positive things have come from it.
So it just seems awfully coincidental that it came one day after the Australian awards.
MONICA ATTARD: Well clearly you don't think it's coincidental.
CHARLIE TEO: No I don't think it's coincidental. But you know I don't know but it seems awfully coincidental to me.
MONICA ATTARD: Okay now I know that you've said that you don't have any concerns with it. But there are some people who do and they are eminent. So let's just go through...
CHARLIE TEO: Yeah absolutely.
MONICA ATTARD: ..some of those arguments if you don't mind.
I mean the Royal Australasian College of Surgeons says non-medical people should not be allowed into surgery. The college wants to talk about what's been happening with you.
What are you expecting when those talks occur?
CHARLIE TEO: If I could take one step back - in the olden days yes, they used to let the public in to watch from balconies.
They realised then that they were selling themselves short or things were happening that they didn't want the public to know so they banned the public. And they put themselves in a bit of an ivory tower where they hid a lot of what was going on behind closed doors.
And then along came audio-visual advances and filming of surgery etc, etc for teaching purposes. And then that of course disseminated to the public, rightly or wrongly.
And then the public started realising that in fact it was not only very interesting but also very educational. And it broke down some of those barriers that were hitherto constructed.
I think in fact that the olden days have done, we've done the full circle; that the public are now being invited in rightly or wrongly into the operating room. I think rightly. Other people think wrongly. And that's something that we have to actually accept because there's nothing we can do about it.
MONICA ATTARD: But why? Why do you think we should accept it?
CHARLIE TEO: We can't stop it. It's on Youtube. If you Youtube craniotomy you can see craniotomies on Youtube. So it's there.
If you Youtube rhinoplasty, Youtube any sort of medical condition you can see a video.
Yeah I'm sure a lot of it has been approved and consented properly. It's then been shown at say some scientific forum. And then someone has taken it from that scientific forum and disseminated to the public. So it's there.
You can go to websites. Anyone can go to a website right now and see an operation. So you can say rhinologyarchives.com and there's surgeons from all around the world showing their operations. You don't need a password to get in.
The second thing is what are we trying to hide by not letting the public see it? Yes we certainly want to try and hide the person's identity and that has been done thankfully.
All those Youtube clips you don't know who's being operated on. And certainly when I show videos you don't know who's being operated on.
So patients' anonymity should be kept precious. That's the first thing.
The second thing is are we trying to hide the actual surgical technique or what goes on in the operating room? And in the olden days, yes maybe they did try and hide the mistakes.
But I don't think you should do that. I think it's legitimate to not only show the successes but also the failures. And then that would again I think would only add to the public's knowledge of what goes on behind closed doors.
MONICA ATTARD: Okay now the anonymity of the patient is a really interesting point and I want to get to that.
But before we do can I ask you, Dr Simon Chapman who has raised a lot of these issues, these ethical issues in a paper that he's published, and the College of Surgeons have raised these issues.
They're concerned about a patient feeling under pressure to agree to having an observer in the room because they want to please you; that even though you're not involved in the asking, that members of your staff do the negotiating with the patient, that there might be an unfair sense of obligation that's easily exploited.
Is that of concern to you?
CHARLIE TEO: Yeah. It was a concern even before this issue was raised publicly, so much so that I've tried to circumvent that by a certain protocol in our office.
For example I would never ask the patient. I think that does...
MONICA ATTARD: Does it make a difference whether you're asking or your staff are asking?
CHARLIE TEO: Oh I think so, absolutely because you know it's a very objective, official sort of situation outside in the office.
They get four consent to sign.
They sign an informed consent about the operation. They sign a consent about financial consent, about paying the gap. They sign a consent about their tissue being taken and put in a bank.
And they sign a consent about photos being taken and the public being allowed to watch the surgery.
And then they take them home. They can discuss them with their families. They don't have to sign them on the spot.
So yeah, no I think it's a very objective way of doing it. I think it does take away that emotional coercion that may be associated with it. And I've been cognisant of it right from the start.
And furthermore it's been reinforced to me that they do have a say and they can reject me because patients do reject it. And that's not uncommon.
I mean it doesn't happen that often but at least once a month a patient would say, actually no, they won't tick that box. I feel good about that.
MONICA ATTARD: Would you imagine then with a patient who for example was not particularly say educated, who comes to you for help and you agree to do the operation. You ask them for their consent to have observers in the room.
They're desperate for your help. They're desperate to please you because you're the person who is going to save their life hopefully or preserve their life for a little longer.
Is that informed consent?
CHARLIE TEO: I think it's informed if they ask you further questions. And people have done that.
For example if you just sign a form and you don't really know what's going on - what does this mean? Are you just going to take pictures with a camera or what? So they ask you know, what does this mean? Who's going to be in the room? And I'll tell them.
Well hang on doctor, is it going to affect your performance? Are you going to be nervous for example?
So yeah, then you have to explain to them what it's all about. And again I think that's good.
I think this whole debate's been good actually. You'll hear that I've never been critical of Simon Chapman. I know he's critical of me.
But the whole issue does need to be raised because I am sure, I hate to say it but I'm sure there are people out there who do have hidden agendas and who do sort of emotionally coerce patients.
I know of one personal example. When I first came back I was on Channel Nine and the producer said that a surgeon, neurosurgeon went to her and said, "Can you film this operation? It's breaking ground. It's very good."
So they went to film it. He was very nervous, clearly nervous. Patient did very poorly, had a bad complication in the operating room.
MONICA ATTARD: Did you report that incident?
CHARLIE TEO: No I didn't report that incident no.
MONICA ATTARD: Is that not something that you would feel an obligation to report to the Royal college?
CHARLIE TEO: There's a lot of things that have happened to me that I probably should have reported to the college.
MONICA ATTARD: No but that incident where a patient suffered?
CHARLIE TEO: Yeah, no, no there are instances as well Monica where patients have suffered at the hands of my colleagues, a lot of cases. But I haven't reported them.
MONICA ATTARD: And why not Dr Teo?
CHARLIE TEO: Look I know the workings of the college. I know that they gun for people like me but they don't gun for other people. I know that there's a game that you have to play. I know that there is a boy's club that you have to be part of.
And I know that if I spend a lot of time and effort and I would have to, not only emotional time and effort but real time and effort to report to all these cases, I know that they'd end up with a very negative outcome for me.
In other words you know it'd probably be washed under the carpet.
Again I'll give you an example. A patient died that I knew about. It turned out that her relative was a doctor at the hospital that I worked at. He asked me to investigate it.
I wrote a written report, put a lot of time and effort into it, asking for it to be investigated. And I was told very clearly that everything that could have been done was done properly.
So I know that I put a lot of time and effort into that and it came to nothing except a lot of angst for me and a lot of time and emotional turmoil for me.
MONICA ATTARD: And that is because of your standing within the professional community?
CHARLIE TEO: Partly my standing I guess. But again unfortunately doctors are the worst, their worst peer reviewers.
MONICA ATTARD: And they don't like to be judged.
CHARLIE TEO: No, no. I mean why do you think lawyers have made such a living out of medical malpractice suits? Because doctors don't do it well.
That's a statement I'm happy to make because it's made, been made publicly before. We are very bad at reviewing ourselves.
So when someone like me who is truthful to a fault goes to the effort of complaining about one of their colleagues and finds that all that happens to them is they get a slap on the wrist and you get back into your hole Charlie type of attitude, then after a while you just don't do it any more.
MONICA ATTARD: Before we move on to some of the other ethical issues, amongst them privacy which you're already raised, I want to ask you because you do perform surgery abroad a lot, do you find the same standards of jealousy and unwillingness to be criticised in some of the hospitals in which you perform abroad?
CHARLIE TEO: No. Of course not, no.
MONICA ATTARD: So it's an Australian phenomenon?
CHARLIE TEO: Well they may, well you can't be a prophet in your own land. So there may be a Swedish neurosurgeon that gets treated the same way in Sweden as I get in Australia.
But when I was in Sweden last week, oh no, all the neurosurgeons at the Karolinska Institute came to watch. They took me out to dinner. They congratulated me on the great result. They absorbed the information that I taught them like sponges. The local TV stations wanted to film me because the girl had this terrible tumour that I managed to take out.
No, I was lauded like a prophet in that land.
MONICA ATTARD: Do you see yourself as a prophet in a medical sense?
CHARLIE TEO: In a medical sense yes. But I'm not unique. I mean (laughs) there are many prophets in many different vocations.
I happen to be one of the, well you know without sounding too egotistical I am a pioneer. I am doing pioneering stuff in neurosurgery. There is stuff that I'm doing that no-one else is doing or else I wouldn't be invited to Sweden and America and Pakistan and Germany to operate you know.
MONICA ATTARD: Okay let's just go back to the issues then. There's also the issue of privacy when you allow observers in to see your surgery because I imagine the temptation if you were the lucky auction winner to tell the tale at a dinner party and as has been brought up before by Dr Chapman would be quite big.
I mean what if you have a very famous actor on your operating table? Does the observer or the observers know who you're operating on?
CHARLIE TEO: That's never arisen. Well it has arisen of course with Aaron McMillan the quite famous pianist on whom I operated but he requested media coverage.
But no, if I operated on a high profile patient as I have many times I would certainly give them the same option to reject any sort of audience and to remain anonymous, absolutely, yeah.
I've operated on VIPs from America here in Australia and they have wanted to remain anonymous. And we've called them even a different name and the hospital have provisions to call them a different name.
MONICA ATTARD: Do you run checks on who will be in theatre looking on?
CHARLIE TEO: Only in that I meet them. And I feel that I have a good enough social radar to tell good people from bad people.
MONICA ATTARD: Now Dr Chapman has also raised the issue of other doctors or nurses in the theatre feeling self-conscious.
Now the sort of surgery that you do is intricate. I imagine that every millimetre counts.
CHARLIE TEO: Oh yes.
MONICA ATTARD: Are you concerned about the distraction element?
CHARLIE TEO: Oh absolutely. I think some doctors don't perform under pressure. And I think some staff don't work well under pressure.
So I make sure that my staff are very comfortable. You know I've got a bad reputation for being quite callous when it comes to culling staff. So my staff in my operating room, they've been with me for many years. They are selected personally by me.
If I ever felt that one of them felt uncomfortable with an observer in the room, then not only would they feel comfortable to tell me because I socialise with all my staff and they know me well and I consider them friends and we travel overseas together.
But I would also expect that they would approach me and say, look this is not right, or you know you shouldn't be doing that, or I feel uncomfortable. We have a good enough relationship where they can tell me that.
MONICA ATTARD: And has it ever happened that any of your staff or indeed yourself have been distracted by you know what's happening in the observer gallery?
CHARLIE TEO: Never. There was one incident - so I've never had a staff a say I'm distracted by this person or that person or you know you're doing the wrong thing or don't do that or I don't feel comfortable with this.
One of my staff felt comfortable enough to tell me she was uncomfortable with me. What happened was that the observers wanted a photo with me in the operating room and I said, "That's fine." The patient was in the background. And she thought that that was inappropriate so we changed that.
That reinforces to me that my staff feel comfortable enough with me to tell me that they are not comfortable with a certain situation.
MONICA ATTARD: It's an issue of course that has been debated both within the medical profession and outside of the profession. Do you think the general public has a right to a voice in this debate? Or is it essentially do you think a medical ethics question which only the profession is qualified to discuss?
CHARLIE TEO: That's such a good question but I can't answer that. This is what I'll say: I think it all boils down to the doctor. I think if the doctor is a good doctor and has a patient's best interest in mind then he's not going to allow anything to compromise that patient's care.
So the media can say what they like. The hospital can bring in any jurisdiction they like. They can allow this or disallow that.
The bottom line is the doctor has to care for his patient. You have to have that overwhelming sense of welfare for your patient.
And I hate to say it but there are some people who don't and that's why people have to come into the debate. And that's why jurisdiction has to be laid down. And that's why rules have to be made - because some doctors I'm sure have a hidden agenda.
Now most doctors don't. Most doctors are in the game for the right reason. But unfortunately there are a few that give us all a bad name.
I would like someone like Simon Chapman or the public to come and see the way I interact with my patients and see that I care for them more than anything in the world.
And I have a completely different relationship with my patients. I've been criticised for it…
MONICA ATTARD: You have indeed I mean…
CHARLIE TEO: I take them home to dinner. They stay at my home. I call them friends. I go to their weddings. They name their children after me. It's a completely different relationship that I have than most doctors have with their patients.
It's that that gives me not license so much but gives me at least justification to do what I do.
You know they know that it's all very positive. When these people observe surgery what do they go away with? They go away with inspiration.
Some of them go away with thinking, oh my God I'm never going to do medicine like I thought I would. Some of them go away thinking, oh, brain cancer is such a terrible disease, I want to do something about it.
MONICA ATTARD: But I guess the issue is not so much the positives. The issue is in an ethical sense whether it's actually worth it given the downside, given the privacy issues, given the issues of consent, informed consent and coercion.
So in your mind is it all worth it?
CHARLIE TEO: Yes, yes it is.
MONICA ATTARD: Because of the money that's raised?
CHARLIE TEO: Yes because of the money that's raised, because of the education of the public, the inspiration it provides to some people. Yes I think it's worth it.
We have had patients in the operating room that have been supporters of the Cure For Life Foundation, the brain cancer foundation that I started. And they have been so inspired by what they see that they have then donated money. And not only that, they've raised money through balls and dinners and functions.
And so there's this add-on effect, this multiplying effect where if you inspire one person then that person will then go out and be an advocate and an ambassador for your cause and generate money.
MONICA ATTARD: There are many doctors who argue that there are other ways to fundraise from the public but in terms of what you do that what ought to be happening is that you should be leaning on other doctors, who are let's face it generally speaking quite wealthy, to be able to contribute.
CHARLIE TEO: (Laughs) Okay yeah, okay well no…
MONICA ATTARD: Are they not generous in…
CHARLIE TEO: I will make a statement there. I think, yes I've been very upset and disappointed with the contribution from my colleagues for the Cure For Life Foundation for example.
My colleagues operate on brain cancer patients like I do. They must see the misery and the suffering. And yet they don't contribute to the Cure For Life Foundation.
MONICA ATTARD: Is that because of you?
CHARLIE TEO: Yes unfortunately (laughs). Well, yeah, well I don't mind if they start their own foundation and raise money through something else but they don't even do that.
MONICA ATTARD: Dr Teo what happens if the college finds that you've breached one or more of its codes? Would you fight that?
CHARLIE TEO: Oh yeah, I'd fight it tooth and nail. In mean if I've done the wrong thing in terms of broken a set law yeah absolutely. But if it's some fuzzy sort of ethical issue that they're concerned about, yeah I'd make sure I'd fight it because I know that I haven't done anything wrong.
And you're right Monica. There must be one patient out of the thousands I've operated on that felt a little bit uncomfortable about it but didn't say anything. I would certainly take that and try and work with it and make sure it doesn't happen again.
But it's never happened.
MONICA ATTARD: And would it be reasonable if the college pointed to that one particular case and said but even one case is enough to warrant stopping this practice?
CHARLIE TEO: Again I'd have to say yes. In other words if I've operated on 8,000 brain tumours, if 7,999 patients were satisfied, if I'd done the right thing, if I have funded research like I have, if I've raised millions of dollars like I have, and yet there was one patient out there who was unhappy, I think it's a price that you pay. The good would overcome that one bit of bad.
MONICA ATTARD: Dr Teo given all that you've said about your colleagues in this interview, most of which has been quite disparaging, I do wonder why somebody of your stature in the international medical community, why you stay in Australia.
CHARLIE TEO: Well from a professional viewpoint I haven't quite stayed in Australia because as you know I go to America once a month. And I work overseas and I'm a consultant for a German company who really look after me well and listen to what I have to say and develop instruments for me.
So in many ways professionally I have not completely cut my international ties.
From a social viewpoint there's no better country to live in than Australia. And I love Australians.
Look I have been mostly disparaging to a very vocal and malicious percentage of neurosurgeons. But overall doctors have been very supportive. General surgeons for example after this last issue have come out really supporting me.
MONICA ATTARD: So do you feel very isolated?
CHARLIE TEO: Yes. I've felt isolated ever since I came back. And again it wasn't unexpected. I expected that.
There was a time about three years after I came back that I was offered a great job in New York and I came home and spoke to Genevieve and I said, "I can't put up with this any longer. I'm all by myself and I feel very vulnerable and I want to go back to America." And she supported me.
It wasn't until I went paddling on Sydney Harbour in my kayak at 5.30 in the morning and saw how beautiful Australia was that I realised I was doing the wrong thing and I wanted to stay here from a lifestyle viewpoint.
MONICA ATTARD: Dr Teo, a final question if I might. We now have a new health package. Is this something that you see as a positive move towards fixing up what most say is an ailing health system?
CHARLIE TEO: Absolutely. I'm very impressed.
Essentially I think the health system has been ailing. There's been inherent problems in it that I think that are unfixable. And I think this new health package is addressing a lot of those issues.
If you run a hospital on a budget then of course the worst thing you can do is have a full hospital because you go over budget, you get penalised for it.
So it encourages almost poor quality of care. If you provide a great service, patients come in, you go over budget. So of course there was inherent problems with our health system.
Activity based funding is something that the federal and state governments have identified as a way of trying to overcome that. And they're both bringing that into the new packages.
I think it's a fantastic advance in the way we look at health and the way we run our health system.
MONICA ATTARD: That was brain surgeon Dr Charlie Teo ending Sunday Profile this weekend.
Thanks for joining me, Monica Attard. And thanks to our producer Belinda Sommer.
