WEBVTT - Conversations with Cornesy - Dr Charlie Teo 0:00:00.040 --> 0:00:04.520 Goodyvery welcome to conversations. We have a special guest. Not 0:00:04.600 --> 0:00:08.520 that everyone is not special, but Charlie too is a 0:00:08.640 --> 0:00:12.240 unique individual. In twenty eleven, he was appointed a Member 0:00:12.280 --> 0:00:15.240 of the Order of Australia for his pioneering efforts into 0:00:15.320 --> 0:00:19.360 development of I Better Get This right, minimally invasive techniques 0:00:19.400 --> 0:00:22.960 in neurosurgery. In twenty twelve he was invited to give 0:00:23.000 --> 0:00:25.920 the Australia Day Address to the nation, and in twenty 0:00:26.040 --> 0:00:29.560 thirteen he was the first non politician Australian to address 0:00:29.600 --> 0:00:34.080 the US Congress. He was for seven years have named 0:00:34.080 --> 0:00:38.400 the most trusted person in Australia, but there's been issues 0:00:38.479 --> 0:00:42.160 around his brilliance as a neurosurgeon. In twenty twenty two, 0:00:42.200 --> 0:00:44.800 we had to endure a hearing with the New South 0:00:44.840 --> 0:00:49.080 Wales Healthcare Complaints Commission. Now, look, I'll claim bias here 0:00:49.479 --> 0:00:54.120 because I've met Charlie. I've attended his foundation functions. I've 0:00:54.160 --> 0:00:58.000 heard the testimonials from people whose lives he's either saved 0:00:58.080 --> 0:01:01.760 or prolonged. For le Man himself, Charlie, Charlie T, how 0:01:01.800 --> 0:01:02.279 how are you? 0:01:03.120 --> 0:01:05.080 Very good? Cons It's nice to be here. 0:01:06.000 --> 0:01:11.160 We were delayed. You apologize for delaying out chat today 0:01:11.200 --> 0:01:14.720 because you were locked in conversation with the patience of yours. 0:01:14.720 --> 0:01:19.440 Can you give us some indication of how those sort 0:01:19.480 --> 0:01:20.440 of conversations go. 0:01:21.560 --> 0:01:25.880 It's quite ironical actually that you mentioned already the tribunal 0:01:25.920 --> 0:01:28.880 in twenty twenty two, so that's the elephant in the room. 0:01:28.959 --> 0:01:32.280 So at least we can talk about that. And I 0:01:32.280 --> 0:01:34.320 guess at the end of the day, the tribunal found 0:01:34.319 --> 0:01:38.760 me guilty of professional misconduct because of two reasons. One 0:01:38.800 --> 0:01:42.280 that I was overly optimistic and I didn't give patients 0:01:42.319 --> 0:01:45.679 a reasonable idea of the risk of surgery. And two 0:01:45.840 --> 0:01:52.080 is that I gave contrary second opinions to patients about 0:01:52.080 --> 0:01:55.120 whether they should or should not have surgery, and if 0:01:55.120 --> 0:01:59.240 it didn't match the opinion that they got before me, 0:01:59.400 --> 0:02:01.840 then of course that was something that I did wrong. 0:02:01.880 --> 0:02:06.520 I should listen to my colleagues essentially, so to talk 0:02:06.560 --> 0:02:10.560 about an one identified me as a bad surgeon. So 0:02:10.600 --> 0:02:12.919 in fact, even my greatest attractors have said that I'm 0:02:12.960 --> 0:02:15.720 a talented, good surgeon. So they all had to do 0:02:15.840 --> 0:02:22.440 with my consent process. So when I heard that, that's 0:02:22.480 --> 0:02:25.440 the one thing that I'm actually most proud of, and 0:02:25.639 --> 0:02:28.600 many of my fellows who come to learn from me 0:02:30.160 --> 0:02:33.520 from overseas, from the most you know, the most reputable 0:02:33.639 --> 0:02:37.080 universities in the world, they almost always say, you know, 0:02:37.120 --> 0:02:39.840 we've learned so much neurosurgeon Charlie. But what we've learned 0:02:39.880 --> 0:02:42.919 mostly is how to treat how to treat our patients 0:02:42.919 --> 0:02:47.240 with respect and autonomy. And so the reason I was 0:02:47.280 --> 0:02:51.160 delayed to this podcast is because, you know, I like 0:02:51.240 --> 0:02:53.839 spending time with my patients. I enjoy getting to know them. 0:02:54.360 --> 0:02:57.839 I don't like rushing the interview. A lot of surgeons 0:02:58.040 --> 0:03:01.840 or doctors in general, give an amount of time to 0:03:01.919 --> 0:03:04.840 their patients and then if that time runs out, they 0:03:04.919 --> 0:03:08.359 could of wrap up the interview and hurried along. And 0:03:08.440 --> 0:03:10.200 I know that if I was a patient, I wouldn't 0:03:10.200 --> 0:03:11.919 want my doctor to do that. I'd want him to 0:03:11.919 --> 0:03:16.520 spend time with me, answer all my questions, be honest 0:03:16.800 --> 0:03:20.359 and be very candid. And that's why I was delayed. 0:03:20.600 --> 0:03:25.040 This patient had a particularly bad tumor. It's life threatening. 0:03:25.680 --> 0:03:29.040 She had received the opinions of many different doctors. She 0:03:29.160 --> 0:03:32.399 was incredibly intelligent and well informed. You know, the last 0:03:32.440 --> 0:03:36.760 thing I wanted to do was rush the consultation. She 0:03:36.880 --> 0:03:40.760 needed a level of comfort and reassurance that I was 0:03:40.800 --> 0:03:44.880 there to talk about her case, to talk about her circumstances, 0:03:45.360 --> 0:03:48.440 and to talk about my experience and my opinion about 0:03:48.640 --> 0:03:50.640 what should and should not be done with her tumor. 0:03:51.680 --> 0:03:54.360 So yeah, ended up being ninety minutes rather than the 0:03:54.520 --> 0:03:57.640 usual sort of an hour, but that's what she required, 0:03:58.000 --> 0:04:00.880 and you very kindly allowed me to sort of delay 0:04:00.960 --> 0:04:04.320 this interview so I could treat her with the sort 0:04:04.360 --> 0:04:06.920 of respect that I'd wanted to be treated with when 0:04:06.920 --> 0:04:07.760 I saw a doctor. 0:04:09.080 --> 0:04:12.320 I've heard you say that when you are discussing outcomes 0:04:12.800 --> 0:04:16.480 with patients, you give them four options. Can you run 0:04:16.520 --> 0:04:17.560 through those options? You know? 0:04:17.640 --> 0:04:20.640 The do? It's a narrative that I used with all 0:04:20.680 --> 0:04:24.200 my patients, and I've used it for the last thirty years. 0:04:24.600 --> 0:04:27.920 And so again, all the more reason why I find 0:04:28.240 --> 0:04:31.799 the findings of the tribunal so abhorrent. So I stayed 0:04:31.800 --> 0:04:34.920 to look. There are four potential outcomes. Is a win win, win, lose, 0:04:35.000 --> 0:04:38.640 lose win, or a lose lose, And sadly, you could 0:04:38.640 --> 0:04:41.520 fall into any one of those categories. Now, sure there's 0:04:42.200 --> 0:04:44.799 more chance you're going to fall into the better categories, 0:04:44.839 --> 0:04:47.400 but you could fall into any category. And lose. And 0:04:47.440 --> 0:04:50.320 a win win is where we do surgery, no complications, 0:04:50.480 --> 0:04:53.719 and we achieve the goal of surgery, either cure or 0:04:53.839 --> 0:04:58.800 prolongation of life. A lose win is where we do surgery, 0:04:59.200 --> 0:05:01.800 we still get the prolongation of life for cure, but 0:05:02.240 --> 0:05:05.640 the complications are such that you have a negative impact 0:05:05.680 --> 0:05:09.560 on your quality of life. A wind lose is where 0:05:09.560 --> 0:05:14.039 we do great surgery, no complications, but the biology of 0:05:14.040 --> 0:05:16.360 the chamber is such that it's just going to grow 0:05:16.400 --> 0:05:18.599 back again and you're still going to die, and we 0:05:18.720 --> 0:05:22.360 haven't achieved the goals of surgery. And a lose lose 0:05:22.760 --> 0:05:27.719 is where sadly you are worse after surgery and it 0:05:27.800 --> 0:05:32.320 still doesn't buy your time or cure you. And sadly 0:05:32.760 --> 0:05:36.280 some patients fall into the lose lose category. And that 0:05:36.320 --> 0:05:40.080 lose lose category is very, very dependent on the location 0:05:40.200 --> 0:05:42.839 of the chairman, the size of the tumor, and the 0:05:42.880 --> 0:05:45.960 biology of the tamer. And I say that to everyone, 0:05:46.279 --> 0:05:52.920 and so everyone is well informed about these potential outcomes. 0:05:53.040 --> 0:05:54.560 At the end of the day, I say to the look, 0:05:54.600 --> 0:05:56.960 there's only one thing I can promise you, And the 0:05:57.000 --> 0:05:58.719 one thing I promise you is that I will try 0:05:58.800 --> 0:06:00.719 my hardest. I'll treat you like a member of my 0:06:00.760 --> 0:06:04.080 own family. And that's the only thing I can promise you. 0:06:04.120 --> 0:06:06.640 I can't promise you good outcomes or bad outcomes or 0:06:06.680 --> 0:06:09.440 no complications, but I can promise you I'm going to 0:06:09.440 --> 0:06:10.240 try my hardest. 0:06:10.839 --> 0:06:13.440 The thing that intrigued me about the findings of that 0:06:13.440 --> 0:06:18.599 that Healthcare Complaints Commission was the composition of the of 0:06:18.640 --> 0:06:20.560 the commission. I mean, you've got a judge, You've got 0:06:20.600 --> 0:06:26.400 two neurosurgeons obviously, who either affiliates of yours or competitors 0:06:26.400 --> 0:06:29.400 of yours, and lay a lay member that's just a 0:06:29.400 --> 0:06:31.880 member of the public who has probably no Is that 0:06:32.000 --> 0:06:36.760 the concern that were they? Were they qualified enough to 0:06:37.520 --> 0:06:38.680 pass judgment on you? 0:06:39.880 --> 0:06:43.960 Absolutely not. It was it was. It was Kangaro Court, Ganti. 0:06:44.040 --> 0:06:47.000 It was terrible, and everyone that was witnessed it witnessed 0:06:47.040 --> 0:06:52.240 it was almost laughable. So the two neurosurgeons had never 0:06:52.279 --> 0:06:55.120 done the surgeries that I'd done. If you looked at 0:06:55.160 --> 0:06:57.960 their CVS, one of them had an impressive CV, but 0:06:57.960 --> 0:07:00.599 it was mostly spying surgeries and epilepsies surgery. And the 0:07:00.640 --> 0:07:03.560 other guy, I had never done a brainstem chimer in 0:07:03.600 --> 0:07:07.320 his life, had never done, had never published, at least 0:07:07.440 --> 0:07:12.000 on recurrent gleomers. They were not peers. They were people 0:07:12.040 --> 0:07:17.040 who were neurosurgeons elected by the Neurosurgical Fraternity to represent 0:07:17.200 --> 0:07:21.120 the standard of care of neurosurgery in Australia. And the 0:07:21.160 --> 0:07:23.640 expert witness that they called in as well was a 0:07:23.640 --> 0:07:28.040 guy that's got zero publications on brain chammers. It was 0:07:28.360 --> 0:07:30.600 ridiculous to you know, I don't mind being judged by 0:07:30.640 --> 0:07:36.600 peers who have the same experience as me, but these guys, well, firstly, 0:07:37.320 --> 0:07:39.480 you know, there's no one in the world who's done 0:07:39.480 --> 0:07:42.120 eleven thousand brain chammits. I'm sorry, but there's just no 0:07:42.120 --> 0:07:45.520 one that's done that. So to get someone at least 0:07:45.680 --> 0:07:48.720 who's done you know, thousands of brain jumors who specialized 0:07:48.760 --> 0:07:51.000 in brain chamans is what they should have done. But 0:07:51.040 --> 0:07:53.760 there's no one in Australia who could fit that bill. 0:07:53.840 --> 0:07:55.880 And not only that, they're my competitors. So it's like 0:07:56.000 --> 0:07:58.960 asking war Was to judge Coles. You know, you just 0:07:59.000 --> 0:08:01.600 can't do that. You've got to get someone who's going 0:08:01.640 --> 0:08:05.520 to be right from the front, as objective and as 0:08:07.240 --> 0:08:09.960 unbiased as you can. And both these guys had a 0:08:10.000 --> 0:08:14.920 record of being malevolent to me, you know, making comments 0:08:14.920 --> 0:08:19.800 about me in public forums, writing letters about me. And 0:08:19.840 --> 0:08:22.760 the reason we couldn't object to that is because when 0:08:22.800 --> 0:08:25.400 we said these guys are biased right from the start, 0:08:25.480 --> 0:08:28.360 they go, Okay, pick two neurosurgeons, aren't biased, and we 0:08:28.400 --> 0:08:34.960 couldn't and well we actually did, but they deemed those 0:08:34.960 --> 0:08:39.400 neurosursions to bias the other way. In other words, our 0:08:39.480 --> 0:08:43.120 friends of mine, they'd either trained with me or they'd 0:08:43.120 --> 0:08:45.480 attended one of my courses, so they were biased the 0:08:45.480 --> 0:08:49.679 other way. And you know, I do conceide that the 0:08:50.120 --> 0:08:53.800 ones that we picked would have been friendlier or more objective. 0:08:54.280 --> 0:08:58.040 So as long as your ban from performing at surgery 0:08:58.080 --> 0:09:02.640 in Australia, you need the approval of other eurosurgeons to do. 0:09:03.880 --> 0:09:04.760 Did I read that right? 0:09:05.280 --> 0:09:07.560 Look, everyone thinks that I'm banned from doing surgery. That 0:09:07.640 --> 0:09:10.839 is not the case. They found me guilty of professional 0:09:10.880 --> 0:09:14.880 misconduct on those two counts and the punishment was a 0:09:14.880 --> 0:09:19.240 reprimand so slap on the rest and that was all. However, 0:09:19.920 --> 0:09:23.400 they did say that you know, you keep bad records, 0:09:23.960 --> 0:09:26.080 and I were the first to admit that I hate 0:09:26.080 --> 0:09:29.679 writing up records and we need you to improve your 0:09:29.720 --> 0:09:33.640 record keeping. Tick, I'll do that, and we'd like you 0:09:33.679 --> 0:09:37.440 to get a second opinion before you do difficult cases 0:09:37.520 --> 0:09:41.640 like brand sim Timbers or recurrently Owmers, And I go, tick, absolutely, 0:09:41.840 --> 0:09:45.000 you know that's great. You know someone else can share 0:09:45.000 --> 0:09:50.640 the responsibility. But they knew that that second requirement would 0:09:50.720 --> 0:09:55.640 never be fulfilled because every neurosurgeon friendly or otherwise who 0:09:55.720 --> 0:09:58.240 I've asked to be my supervisor to give me that 0:09:58.280 --> 0:10:01.640 second opinion have rejected me. And they rejected me on 0:10:01.840 --> 0:10:05.520 very reasonable grounds, and that is that malpractice insurance companies 0:10:05.559 --> 0:10:09.640 have said, don't do it, that he should do this 0:10:09.760 --> 0:10:12.320 case and agree to it. If something goes wrong, you're 0:10:12.360 --> 0:10:15.000 going to be held liable. And if you say he 0:10:15.120 --> 0:10:17.800 can't do it and they die, you're going to be 0:10:17.800 --> 0:10:20.760 held libel. So and they knew that right from the start. 0:10:20.800 --> 0:10:23.199 They knew that no one was going to ever step 0:10:23.280 --> 0:10:28.199 up and be my supervisor or my second opinion. So yeah, So, 0:10:28.240 --> 0:10:30.600 in other words, the restrictions they put on me were 0:10:30.720 --> 0:10:37.240 so onerous that, yeah, I can't operate now. I can 0:10:37.280 --> 0:10:39.680 still operate on other cases where I don't need permission, 0:10:39.920 --> 0:10:44.040 But the trouble is that now that I'm so everyone 0:10:44.160 --> 0:10:47.959 knew before this that my colleagues were against me, and 0:10:48.040 --> 0:10:51.920 so everyone's known that for ages. But now to have 0:10:52.000 --> 0:10:54.320 the media against me as well, it puts me an 0:10:54.360 --> 0:10:59.559 extremely high risk of, you know, a high profile case 0:11:00.960 --> 0:11:05.520 that might go wrong. So now the hospitals are going, well, 0:11:05.520 --> 0:11:07.920 the hospital that I work that goes Charlie. You know, 0:11:08.240 --> 0:11:10.760 you've been great, You've been here for thirty years. You've 0:11:10.760 --> 0:11:12.640 brought a lot of money to our hospital. But now 0:11:12.679 --> 0:11:15.400 it's too high risk. The media against you, your colleagues 0:11:15.400 --> 0:11:18.680 are against you. You need supervisors. And they took my 0:11:18.920 --> 0:11:23.520 privileges away, and again I kind of can't blame them. 0:11:24.640 --> 0:11:26.520 So then I go, well, don't worry, I'll just go 0:11:26.559 --> 0:11:28.680 somewhere else and someone else will give me privileges. But 0:11:28.760 --> 0:11:32.080 everywhere I go, of course, the neurosurgeons have to who 0:11:32.120 --> 0:11:34.960 work at that hospital have to agree to bring me 0:11:35.040 --> 0:11:37.319 on board, and they all circle the wagons and keep 0:11:37.360 --> 0:11:40.200 me out. So now if I had a hospital that 0:11:40.240 --> 0:11:42.600 I could operate in in Australia, I could operate today. 0:11:42.679 --> 0:11:44.920 I still have my license and I still can do 0:11:45.080 --> 0:11:48.320 cases that aren't controversial. In other words, the majority of 0:11:48.360 --> 0:11:51.760 neurosurgery cases I can still do. It's only it's only 0:11:51.800 --> 0:11:56.160 those two particularly difficult cases where I need a supervisor. 0:11:56.440 --> 0:11:58.559 Doctor Charlie TiO is my guest, folks. We need to 0:11:58.559 --> 0:12:01.520 take a break back shortly. Welcome back to conversations. Doctor 0:12:01.640 --> 0:12:04.559 Charlie Teo is my guest, folks. If you just tuned 0:12:04.559 --> 0:12:09.120 in and explained the circumstances of the tribunal hearing that 0:12:09.160 --> 0:12:11.640 he had to go through the Healthcare Complaints Commission and 0:12:11.679 --> 0:12:15.280 at the outcome of that, he can't really operate in Australia. 0:12:15.320 --> 0:12:19.319 But he can operate, but it's a bit too complicated. 0:12:20.360 --> 0:12:23.719 I'm intrigued, though, Charlie. Let me just get this quote up. 0:12:23.840 --> 0:12:26.520 In an interview from Beijing, the Professor Ling Feng, who's 0:12:26.559 --> 0:12:31.319 the deputy director of the China International Neuroscience Institute, said 0:12:31.480 --> 0:12:34.800 she was not worried about the restrictions imposed on doctor Teo. 0:12:36.360 --> 0:12:38.400 She said, I took a careful look into what happened 0:12:38.400 --> 0:12:40.720 over there. I don't think it should be imputed that 0:12:40.800 --> 0:12:44.640 Charlie's neglect of care or passion for the patients. Instead, 0:12:45.000 --> 0:12:48.240 I thank Australia for the restrictions on Charlie, which gave 0:12:48.320 --> 0:12:51.679 me the opportunity to work with him. So you're doing 0:12:51.720 --> 0:12:53.360 a lot of your work overseas now. 0:12:53.480 --> 0:13:00.240 Obviously in China, the enforced retirement from the tribunal put 0:13:00.280 --> 0:13:04.280 me in a bad place. Cornse I don't know. I 0:13:04.360 --> 0:13:07.560 just I love neurosurgery. I still had the passion. I 0:13:07.600 --> 0:13:11.160 was still getting great results. I wanted to pass on 0:13:11.200 --> 0:13:14.440 the wood and disseminate the information before I retired, and 0:13:14.760 --> 0:13:19.120 it just wasn't the right time, and so I sought 0:13:20.400 --> 0:13:25.559 my refuge overseas. I guess I'm lucky enough to have 0:13:25.679 --> 0:13:28.439 had a fellowship program over the last forty years where 0:13:28.440 --> 0:13:31.720 I've trained neurosurgeons from almost every country in the world, 0:13:32.240 --> 0:13:35.240 and so I have friends and colleagues in almost every 0:13:35.280 --> 0:13:39.160 country in the world who were eager to have me 0:13:39.320 --> 0:13:43.040 operate and teach in their countries. And so I initially 0:13:43.120 --> 0:13:47.480 went to Spain where I taught to of the neurosurgeons 0:13:47.520 --> 0:13:52.000 and they were just lovely. And I was operating in 0:13:52.040 --> 0:13:56.400 an environment that was non hostile, and it was the 0:13:56.400 --> 0:13:58.920 first time I'd ever operated in a non hostile environment, 0:13:59.000 --> 0:14:01.679 and I must say it wasting. It was just beautiful 0:14:02.679 --> 0:14:05.560 where you know things are going to go wrong occasionally, 0:14:05.720 --> 0:14:08.080 but in Australia, when things went wrong, I was always 0:14:08.080 --> 0:14:10.880 worried that the knives would come out and the colleagues 0:14:10.880 --> 0:14:14.600 would see it as an opportunity to destroy me, whereas 0:14:14.600 --> 0:14:19.400 overseas it was exactly the opposite. They was supportive. They 0:14:19.480 --> 0:14:23.960 saw it as a teaching lesson. You know, if Charlie 0:14:23.960 --> 0:14:26.440 can get a complication like that, then you know anyone can. 0:14:27.240 --> 0:14:30.840 And it was a it's a beautiful environment to operate in. 0:14:31.640 --> 0:14:34.360 So from Spain I then went and you know, people 0:14:34.400 --> 0:14:37.960 heard that I wasn't operating in Australia and they invited me. 0:14:38.040 --> 0:14:41.720 So I've operated in God, it's like I can't even 0:14:41.720 --> 0:14:43.800 listen to them all India. 0:14:44.400 --> 0:14:50.040 All Peru, Spain, Germany, Nepal, three three and three in Nepaul, Brazil, 0:14:50.160 --> 0:14:54.600 South Africa, India, China. And then it's intriguing to see 0:14:54.640 --> 0:14:59.960 the outcome where the statistics have given me love successful 0:15:00.120 --> 0:15:03.000 come one hundred and forty five, a good outcome, twenty 0:15:03.400 --> 0:15:08.080 a fair outcome, thirty three, a fair outcome three one 0:15:08.520 --> 0:15:13.400 unfortunate death out of those operations you've done. Now, who 0:15:13.400 --> 0:15:16.920 compiles those figures? Are you know they peer compiled? 0:15:18.000 --> 0:15:20.120 Yes, So you have to keep a log book with 0:15:20.160 --> 0:15:22.960 all the surgeries you do, and you have to document it, 0:15:23.080 --> 0:15:26.280 and so all those cases have been well documented. We've 0:15:26.280 --> 0:15:28.520 got X rays before and after, et cetera, et cetera. 0:15:29.440 --> 0:15:31.880 And then of course they're endorsed by the Chairman of 0:15:31.880 --> 0:15:36.440 the Department, and so they're very accurate figures, they're legitimate, 0:15:37.440 --> 0:15:40.000 and they're actually not as good as my normal figures. 0:15:40.040 --> 0:15:42.520 So one death in you know, in one hundred or 0:15:42.520 --> 0:15:47.080 two hundred patients is unusual. But in my defense, the 0:15:47.080 --> 0:15:49.600 cases I'm doing are like the world's most difficult cases. 0:15:49.640 --> 0:15:52.280 When I operate in a country like Nepal and Cambodia, 0:15:52.720 --> 0:15:55.360 which I did last week, they don't give you the 0:15:55.440 --> 0:15:58.000 cases that they can do. They give you these really 0:15:58.040 --> 0:16:00.920 really difficult cases that no one is prepaired to operate on. 0:16:01.120 --> 0:16:04.800 So of those, I forget how many there are, but 0:16:04.840 --> 0:16:08.120 of those, say two hundred cases, easily one hundred and 0:16:08.160 --> 0:16:10.960 fifty of them are the world's most difficult cases that 0:16:10.960 --> 0:16:13.880 no one else will operate on. So I know those 0:16:13.880 --> 0:16:16.160 figures don't look good with one death out of one 0:16:16.200 --> 0:16:20.000 hundred and forty patients, because normally I have, you know, 0:16:20.360 --> 0:16:22.960 in my eleven thousand cases, I had twelve deaths. So 0:16:23.120 --> 0:16:25.880 the figures are much better than that, but these are 0:16:25.920 --> 0:16:28.280 really difficult cases that I've been operating on. 0:16:28.640 --> 0:16:30.680 I can't imagine what it would be like to operate 0:16:30.720 --> 0:16:35.200 in Nepal. What sort of conditions do you operate exactly? 0:16:35.520 --> 0:16:38.800 Exactly. You've got to adapt to the conditions that are available. 0:16:38.920 --> 0:16:43.160 Like Nepal was actually not too bad. But in Cambodia 0:16:43.280 --> 0:16:45.440 they don't have a drill, so you've got to use 0:16:45.480 --> 0:16:47.360 the old fashioned way of opening the skull with this 0:16:47.520 --> 0:16:51.480 wire called a jiggly saw. They don't have a headholder, 0:16:51.600 --> 0:16:54.640 which means that the patient, if they wake up, will 0:16:54.640 --> 0:16:58.920 move during the operation. Then it can be disastrous. So yeah, 0:16:58.920 --> 0:17:01.960 you have to make all these sessions about what you 0:17:02.040 --> 0:17:05.520 can and can't do because of the limitations in technology 0:17:05.560 --> 0:17:07.520 and equipment and expertise. 0:17:08.240 --> 0:17:09.960 Patients wake up during an operation. 0:17:11.280 --> 0:17:14.560 Yeah, if the antithesiologist is not on the ball, they are. 0:17:15.080 --> 0:17:16.840 And even if they are on the ball, even good 0:17:16.840 --> 0:17:20.000 ant caesiologists will have the occasional patient that will move 0:17:20.119 --> 0:17:24.200 during an operation because they absorb the anesthetic agents faster 0:17:24.560 --> 0:17:28.879 or are more efficiently than others. And so everyone's different, 0:17:29.040 --> 0:17:32.040 and it's not unusual for a patient to move a 0:17:32.080 --> 0:17:34.920 little bit during an operation as the anesthetic agents wear off. 0:17:35.640 --> 0:17:37.760 That's why you put them in three pin fixation. We 0:17:38.119 --> 0:17:40.280 put them in three pin fixations so that if they 0:17:40.320 --> 0:17:42.719 do have the move, the head doesn't move. And so 0:17:42.760 --> 0:17:47.679 while you're doing delicate neurosurgery where every millimeter counts, it 0:17:47.680 --> 0:17:49.800 doesn't matter, it doesn't affect you. Now, when you don't 0:17:49.840 --> 0:17:52.119 have a headholder, it means you've got to take the 0:17:52.200 --> 0:17:56.639 head down, which with a sticky tape and that's the 0:17:56.680 --> 0:18:00.240 best you can do. And so the patients have to 0:18:00.280 --> 0:18:04.919 be really, really obsessively anesthetized so they don't wake up 0:18:04.920 --> 0:18:08.119 and they don't move during the operation. But that of 0:18:08.160 --> 0:18:12.439 course introduces another lay of complexity because the more an 0:18:12.440 --> 0:18:15.280 aesthetic agency is, the more expensive it is for the patient. 0:18:15.680 --> 0:18:18.680 And remember these patients are paying for their own anesthetic agents, 0:18:20.040 --> 0:18:23.199 and it means they wake up less quickly, and you 0:18:23.240 --> 0:18:26.199 know all these other all these other potential complications that 0:18:26.240 --> 0:18:27.919 you've got a factor in when you operate in a 0:18:28.280 --> 0:18:29.320 developing country. 0:18:29.720 --> 0:18:32.240 What is an operation like that cost, Charlie. 0:18:33.040 --> 0:18:36.120 Yes, So if it's a surgery in a developing country 0:18:36.160 --> 0:18:38.600 and I'm doing it to teach the local neurosurgeons, of 0:18:38.600 --> 0:18:41.000 course it's all pro bono, so I don't charge a 0:18:41.080 --> 0:18:45.800 patient anything, and you know that's usually done in a 0:18:45.800 --> 0:18:48.120 public hospital, so they don't pay anything, or they pay 0:18:48.160 --> 0:18:51.439 a little bit. If it's a private patient who's insisted 0:18:51.480 --> 0:18:54.200 on meeting the operation, then I charge them a fee, 0:18:54.840 --> 0:18:57.960 plus the hospital charges them a fee, and that fee 0:18:58.040 --> 0:19:01.080 can vary according to which country you're in. The total 0:19:01.119 --> 0:19:03.760 fee can vary from as little as twelve thousand dollars 0:19:03.760 --> 0:19:05.960 in some countries, so as much as one hundred thousand 0:19:05.960 --> 0:19:11.359 dollars in other countries. So yeah, it's not cheap, but 0:19:11.440 --> 0:19:15.480 it's very comparable and in most cases cheaper than Australia. 0:19:16.160 --> 0:19:20.720 So in Australia, if a patient wanted me to operate 0:19:20.840 --> 0:19:25.000 privately and they didn't have private health insurance, the total 0:19:25.000 --> 0:19:27.159 bill would end up being somewhere between eighty and one 0:19:27.200 --> 0:19:30.679 hundred thousand dollars. Again, everyone accused me of taking that 0:19:30.800 --> 0:19:34.040 hundred thousand dollars, which is ridiculous because everyone knows that 0:19:34.080 --> 0:19:37.919 you've got to pay the hospital as well. But you know, 0:19:38.000 --> 0:19:41.439 in Spain, for example, it's twenty thousand dollars cheaper than that. 0:19:41.600 --> 0:19:44.159 In China it's thirty forty thousand dollars cheaper than that, 0:19:44.320 --> 0:19:47.880 so it really does depend on which country you're operating in. 0:19:48.400 --> 0:19:51.200 Doctor Charlie Teo as my guest, folks, something I'm intrigued 0:19:51.240 --> 0:19:54.320 about his journey from where he came to where he 0:19:54.400 --> 0:19:56.399 is now, so we'll talk about that after the break 0:19:56.480 --> 0:19:58.879 back shortly. Welcome back everybody. If you just tuned in 0:19:58.960 --> 0:20:02.840 with speaking to doctor Charlie TiO, one of the most 0:20:02.840 --> 0:20:08.080 eminent neurosurgeons in the world, renowned for his skill, not 0:20:08.160 --> 0:20:12.760 without his controversy. Charlie, I'm always intrigued in the journey. 0:20:13.119 --> 0:20:17.320 I mean, you're obviously of Asian extraction. Can you tell 0:20:17.400 --> 0:20:20.639 us about mum and dad in your early days? 0:20:21.280 --> 0:20:25.920 Yeah, well, you know, it is quite a checkered upbringing 0:20:25.960 --> 0:20:33.920 of past. But in summary, so both parents Chinese from Singapore, 0:20:34.600 --> 0:20:38.119 immigrated to Australia to do medicine. My father was an 0:20:38.119 --> 0:20:43.840 obstrician gynecologist. Before that he was a GP. My mum 0:20:43.920 --> 0:20:48.760 was a nurse. Not a wealthy sort of background. We 0:20:48.800 --> 0:20:50.960 did it hard at first. 0:20:51.240 --> 0:20:53.520 Were you born when they immigrated? 0:20:54.520 --> 0:20:57.440 No, I was born here. Okay, yeah, yeah, so they immigrated, 0:20:57.480 --> 0:21:01.160 I was born here and the first say ten years 0:21:01.160 --> 0:21:04.200 of my life was pretty hard. Little fire Row house, 0:21:06.920 --> 0:21:10.320 I bought Bomby sort of car, and I can just 0:21:10.440 --> 0:21:16.760 remember it wasn't the most salubrious situation. But then they 0:21:16.800 --> 0:21:20.119 sent me to a private school, so things obviously got better. 0:21:21.440 --> 0:21:23.800 I went to Trinity Grammar initially, and then I went 0:21:23.800 --> 0:21:28.520 to Scott's College. From there, I decided I wanted to 0:21:28.560 --> 0:21:33.560 be a motor mechanic. I chose an apprenticeship, and then 0:21:33.600 --> 0:21:37.719 I realized that it wasn't intellectually stimulating as I wanted, 0:21:37.800 --> 0:21:41.400 so I actually got the march again in medicine, got 0:21:41.440 --> 0:21:44.760 into medicine, and the rest is history. 0:21:45.600 --> 0:21:49.639 Well, you just skipped over too quickly. Do you have 0:21:49.680 --> 0:21:53.280 any connection and did your mother and father maintain a 0:21:53.359 --> 0:21:56.119 connection with Singapore, given that's where they were born. 0:21:57.359 --> 0:22:00.359 You know, it was in the days, Cornsey, that and 0:22:00.400 --> 0:22:05.160 most of your listeners won't be of this vintage, but 0:22:05.320 --> 0:22:08.600 it was in the days that the population of the 0:22:08.640 --> 0:22:12.760 colonies wanted to be more English than the English, and 0:22:12.800 --> 0:22:16.000 that's why a lot of the Chinese called their children 0:22:16.320 --> 0:22:20.720 very very English names like Winston and Hamilton and Charles, 0:22:21.600 --> 0:22:25.359 and I was called Charles after Prince Charles. My mother 0:22:25.440 --> 0:22:29.639 was Elizabeth, my father was Philip. My sisters ann so 0:22:30.520 --> 0:22:35.720 where you can't get more anglophilic than that. So no, 0:22:35.880 --> 0:22:41.000 they didn't really reject their heritage, but they certainly didn't 0:22:41.040 --> 0:22:44.119 want me to be Chinese. They wanted me to be 0:22:44.160 --> 0:22:48.919 more English and more Australian than them, So you know, 0:22:49.000 --> 0:22:51.240 they chose not to speak Chinese in front of me, 0:22:51.560 --> 0:22:55.680 so I would never speak with a Chinese accent. They 0:22:55.800 --> 0:22:58.359 sent me to a greater public school where they wanted 0:22:58.400 --> 0:23:00.240 me to row in the head of the river and 0:23:00.280 --> 0:23:04.879 played rugby, and so all those very English things were 0:23:05.000 --> 0:23:07.880 encouraged now household, rather than discourage. 0:23:08.400 --> 0:23:10.080 Did you row? Did you play rugby? 0:23:10.760 --> 0:23:13.000 I did row? I wrote in the Social four, because 0:23:13.040 --> 0:23:14.720 I was never big enough or strong enough to be 0:23:14.960 --> 0:23:19.359 in a competitive four or competitive eight. I played rugby, 0:23:19.400 --> 0:23:21.159 and I was very good when I was young, but 0:23:21.200 --> 0:23:23.720 then everyone got bigger than me and faster than me, 0:23:23.960 --> 0:23:27.600 and so by the time I finished playing rugby, like 0:23:27.640 --> 0:23:29.560 I was in the eleven a's and ten a's and 0:23:29.600 --> 0:23:32.320 twelve a's and then the thirteen b's and then the 0:23:32.320 --> 0:23:37.600 fourteen c's and then the fifteen d's, and so by 0:23:37.640 --> 0:23:42.560 the time I got to my senior years, that's not true. 0:23:42.560 --> 0:23:44.480 I actually played in the seconds for a game I 0:23:44.560 --> 0:23:48.800