March 24, 2025 • 57 mins
Dr. Laura Yeates shares her journey as a cardiac genetic counsellor specialising in inherited heart diseases and supporting families affected by sudden cardiac death. We explore her recent PhD research on developing support interventions for these families and discuss the importance of wellbeing for genetic counselling professionals. • Cardiac genetic counselling focuses on inherited cardiomyopathies and arrhythmias • Dr. Yeates completed her PhD during COVID, developing support interventions for families affected by sudden cardiac death • Genetic counsellors need a personalised "self-care toolkit" that evolves throughout their career • The importance of multidisciplinary team meetings where genetic counsellors provide valuable expertise • "Mainstreaming" works best when genetic counsellors are embedded within specialty departments • Being called "stat" to map a complex family tree validated the unique skills genetic counsellors bring to healthcare teams • Certification is challenging but valuable, making genetic counsellors more reflective practitioners • The profession requires continuous learning as "the technology we'll be using in 10 years hasn't been invented yet"
Demystifying Genetics is sponsored by TrakGene https://www.trakgene.com/
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Episode Transcript
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Matt Burgess (00:00):
My name is Matt Burgess and I am a genetic
counsellor.
I am also the host of thispodcast, demystifying Genetics.
After finding my first geneticcounselling job and being in the
role for a few years, I beganthe process of board
certification.
I became certified by the HumanGenetic Society of Australasia
in genetic counselling 15 yearsago now.
(00:22):
Today's guest is Dr Laura Yates.
Laura is a cardiac geneticcounsellor based in Sydney who
has recently finished a PhD ingenetic counselling.
Join us for a greatconversation about certification
of genetic counsellors and lotsof other interesting topics.
And a big thank you to our mainsponsor, trackgene topics, and
(00:49):
a big thank you to our mainsponsor, trackgene.
Okay, hello, laura, and welcometo Demystifying Genetics.
Laura Yeates (00:51):
Hi, Matt, thanks for having me.
How are you?
Yeah?
Matt Burgess (00:54):
good, excellent.
Now, obviously I know you quitewell.
However, what I thought I couldask to start with is you know,
when you're like at a barbecueor a social function and you
meet like a friend of a friendand they say oh Laura what do
you do Like?
(01:14):
What's your sort of 90 secondsort of grab about what you do?
Laura Yeates (01:21):
Oh yeah, well, I love this question.
But I love I always say, well,I'm a genetic counsellor, and
then they pause and kind of lookat you If they haven't heard of
you, which most people haven't,they're like a what, a what?
Counsellor, and then I wouldsay I help families affected by
inherited disease and in my caseI've specialised in inherited
(01:43):
heart disease or cardiacconditions.
Matt Burgess (01:46):
Excellent yes, I remember.
Oh, I think I was like sick,like off sick from school, so
like maybe it was when I was inlike grade nine or ten or
something and Oprah was on and Iremember her talking about long
QT syndrome and I thought itwas fascinating.
And now I'm a geneticcounsellor, so I don't know if
(02:10):
there's any sort of link there,but You're here because of Oprah
.
Oh, so I have so manyinteresting things to talk to
you about, but maybe firstthings first.
Congratulations.
You have recently finished aPhD in genetic counselling.
How was the process and how areyou going now that you have
(02:32):
finished?
Laura Yeates (02:34):
Oh, I mean it was a great process.
It was kind of wild is a goodword for it.
I started my PhD in January of2020.
So things quickly changed witha global pandemic.
So I've heard some people saythat doing a PhD during COVID
would be way easier, but I don'tactually think it was.
(02:57):
Like others, I was trying toshare a kitchen table to do my
workday and taking conferencecalls in the backyard while we
were under lockdown and a coupleof my studies fell over because
we couldn't recruit.
While clinics weren't running,my primary supervisor moved to
institutes, which was a reallygreat thing, but just added
(03:17):
complications with gettingethics approval and extra
paperwork.
So there was a lot of stressfultimes in that, but also just
really joyous times.
Um, I really loved having timeto think and and deep dive, um
into like some of the literatureand just um, I did a lot of uh,
(03:38):
I did a bit of co-supervisingand master of genetic counseling
students during that time.
So was a student myself, butthen trying to also learn what's
the best way to get the bestout of your students in their
projects.
Yeah, I just had a great teambehind me and and yeah, I got to
do some great projects, bothwith families affected by sudden
(03:59):
cardiac death which is alwaysalways a privilege just for to
hear their stories and learnfrom them and got to do some
great work in well.
I think it's great, reallyfascinating work in genetic
counsellor wellbeing.
So that's also a passion ofmine.
Thinking about how do we makesure that we look after
(04:20):
ourselves so that we have a longand fruitful career is
something I'm really passionateabout.
So, yeah, it was crazy.
There were many times I didn'tthink I'd make it and I didn't
think I'd hand in, but I did andI've passed and it's all just
waiting to have my graduationceremony.
But yeah, I just had some.
I had the opportunitythroughout that it just opened a
(04:41):
lot of doors of different waysthat I could learn from
different people, not only mysupervisors but, um, just you
know, collaborators and otherresearchers and, um, uh, my
research participants as well.
Yeah, it's good.
Congratulations, that's a.
Matt Burgess (04:57):
It's a great achievement.
So tell me more about cardiacgenetics.
I know sort sort of you knowthat's a very broad and open
question, but I guess it's sortof similar to cancer when we
think of genetics.
A lot of cardiac conditions donot have a strong inherited
(05:19):
component, but then there arequite specific genetic diseases
or conditions where there is astrong genetic link.
So maybe if you could give thelisteners a little bit of an
overview of the different typesof conditions that you see, yeah
, sure.
Laura Yeates (05:35):
So I guess, to take a step back, like going
back, I trained in 2006,.
Right, I did the grad dip inMelbourne and then jobs were
really hard to come by.
But there was this job going inthe genetic heart disease
clinic at RPA, which I then gotand moved myself to Sydney and I
guess it was there that, like Ishould say, we did no cardiac
(06:01):
genetics in my training.
This is how new this field was.
Matt Burgess (06:04):
That was funny.
I I was just about to say howmany lectures did you do,
because I also did a one-yeargenetic counselling course and I
think I probably did a onetwo-hour cardiac genetics lesson
.
Laura Yeates (06:15):
Yeah, no, I mean I was lucky enough I'd started
applying for jobs quite earlybecause I was quite worried that
I wouldn't get a job, as wasthe state of play back in the
2000s, and then I landed the jobup in Sydney and then my final
placement was with Ivan Machokain Melbourne who was a cardiac
(06:35):
genetic counsellor, and so Ithink through my four week
placement we had maybe onecardiac clinic, and so I was
likeonne, you need to teach meeverything you know.
He was very gracious and so,yeah, I learned as much as I
could from him in a very smallamount of time and then moved up
to Sydney.
So the conditions that wefocused on at RPA were the
(06:57):
inherited cardiomyopathy, so theinherited muscle problems,
heart muscle problems, sothickening of the heart or when
the heart gets big and baggy.
We also focus on the inheritedarrhythmias, so in those the
heart is a normal size butthere's rhythm problems of the
heart like long QT syndrome.
There are lots of other heart,familial heart conditions, like
(07:19):
what we call aortopathies orconditions of the aorta but
there was a separate clinic atRPA for those, so I didn't see
those and also the same withfamilial high cholesterol, which
can cause early coronary arterydisease.
So, again, a separatespecialist clinic for those, and
so, yeah, my focus was verymuch on the inherited
(07:40):
cardiomyopathies, the inheritedarrhythmias, the inherited
cardiomyopathies, the inheritedarrhythmias.
And then we also had aspecialist focus on caring for
families who have had a youngperson pass away suddenly, and
often it's the firstpresentation of disease, so the
family have no idea that there'sthis heart condition in their
family and then someone justdrops dead, and so it's a pretty
(08:02):
horrible time just drops deadand so it's a pretty horrible
time.
Matt Burgess (08:08):
I think obviously there are many different areas
of clinical genetics, but whenwe think about cardiac genetics,
you know it's quite common thatwe see families where there is
sudden cardiac death.
And just to think about howdevastating that must be to not
even know that there's a geneticcondition and then a loved one
passes away so suddenly andunexpectedly, you know,
(08:29):
sometimes at a really young ageand then to realise that maybe
other people in the family arealso at risk of this, like it's
just incredibly difficult.
Laura Yeates (08:39):
Yeah, 100%, 100%.
Matt Burgess (08:41):
So in your PhD, 100%, 100%.
So in your PhD, how did thecardiac genetics come into it?
Because I think you were sortof involved with looking at the
families and how the familiessort of come into it.
Is that right?
Laura Yeates (08:57):
Yeah, I mean we had, so I'd worked.
I worked in the prior to my PhD.
I'd worked full time in thecardiac genetic clinic for I
think it was about 12 years, andat that point I was, I guess,
looking for a new challenge.
You'll find about me I don'tsit still very well.
I, yeah, I needed to stretchmyself a bit more.
(09:17):
I was also a bit tired, neededa change of pace, and so was
thinking about what was next.
Like, did I want to move into adifferent?
area of genetics, I had alwaysthought about doing a PhD.
And then the Heart Foundationhad some.
They had opened up theirscholarships from just offering
(09:38):
PhD scholarships tocardiologists.
They'd opened them up to alliedhealth as well, and so I
thought, well, this is going togoing to be my best chance.
You know, doing your PhD laterin life and going back to a
student budget is quite hard,but these are quite generous
scholarships and so this waskind of going to be my best
chance.
And also, I had just, I think,seen these families and we we,
(10:01):
you know over.
So the clinic I work in, orworked in, had a really strong
clinical and research focus.
So, working with other geneticcounselors, like Jodie Ingalls,
we had really described and seena lot of, I guess, ask
questions of our patients aboutwhat it's like to lose someone
(10:21):
suddenly.
And actually, you know, a paperthat I did in 2013 as part of
my certification talked aboutthe psychosocial impact on
families and just how theydidn't cope very well, and
mothers particularly didn't cope, and so we had sort of measured
this.
We did a needs analysis and thefamilies were telling us we
need more support and we needmore information, and so I was
(10:45):
like, well, I can keep sayinghow there's a problem and the
system's broken, or I can do aPhD and try and find some a
solution, and so that's what Idid.
So my PhD focused on Ico-designed with focus groups a
support intervention forfamilies affected by sudden
cardiac death, and so from thosefocus groups, they told us they
(11:07):
wanted an avenue for peersupport and they wanted more
information.
And then some of our other work.
They had also talked about justwanting someone, almost like a
caseworker or something to takethem through the process after
sudden cardiac death.
And so you know I can come backto that a bit later about what
(11:28):
we're doing post-PhD, but that'sa real focus.
But for my PhD, we then, afterthe focus groups, went about
developing a website and someonline support sessions based on
the feedback from those focusgroups.
And then I measure.
So I wrote all the content forboth parts of the intervention
and then assessed theacceptability.
(11:49):
So, like before I did my PhD,I'm like, oh, something's
acceptable or it's notacceptable, but it turns out
it's more complicated than that.
So, yeah, I used a theoreticalframework of acceptability just
to to look at seven different umareas or constructs of
acceptability and, uh, to makesure that the intervention we
(12:10):
developed was acceptable tofamilies, which was excellent,
and I guess you know when wethink about um research.
Matt Burgess (12:21):
Um sorry, my dog has just come home I'm gonna
close the door there.
When we think of research.
Uh, you know you can gatherdata in like a quantitative way
and sort of like, um, ask peoplequestions and get them to sort
of jot down answers and and youknow numbers and sort of short
(12:42):
answers, but then you can alsosort of talk to people and you
know that's more of aqualitative sort of approach.
What is sort of the approachthat you took and is that sort
of what you enjoy doing?
Laura Yeates (13:01):
Yeah, I took a mainly qualitative approach and,
yes, I I'm a massive talker, asyou can tell, but I just love
hearing uh people's stories andI think there's a lot to learn
just from people's experienceand um, you know, just asking
the right or probing questionscan just tell you a lot about um
(13:23):
, about either what it's like tolive in a family where
someone's died or live with aninherited heart condition, um,
or my, you know, my otherproject of my phd was about
genetic health, a geneticcounselor, well-being, so how,
as practitioners, we maintainwell-being.
So, asking about thatexperience and hearing what
works for some GCs and not forothers, um, yeah, I just think
(13:47):
there's a lot of power instorytelling um, you know, and I
think of uh IndigenousAustralians and their traditions
of storytelling as just areally beautiful um way to pass
on wisdom to the next generationand um and learn.
Yeah, I've always liked a bitof qualm, yeah, but mainly
(14:10):
because I just love talking topeople and hearing from them and
their story.
Matt Burgess (14:15):
I think I'm exactly the same.
I really like qualitativeresearch, where you know you
kind of come up with an idea andthen you can sort of do a deep
dive with people and ask themquestions.
And then what was sort ofsurprising for me was when I
came time to sort of code andanalyze and I don't know in my
(14:36):
mind I thought, oh, that's a bitsort of analytical and I don't
like that, but I actually reallyenjoyed it.
Laura Yeates (14:40):
It's like, oh, you know, these people kind of said
, oh, you know, this is sort ofsimilar here, or you know, lots
of people sort of said the samething and that surprised me and
yeah, I really quite like thatsort of side of qualitative
research yeah, and and how youknow, around a central point
there can actually be quite avast area of you know of of
(15:02):
opinion, and that that's okay,you know, like that's just the
spectrum of opinion withinwhatever issue that you're
talking about is also justreally fascinating.
Even though these people mighthave the exact same disease and
have had a similar course of ofdisease in their life, similar
impact, they can have verydifferent interpretations of
(15:24):
that on their own life and yeahyou know that's to be celebrated
um the variety that comes inthat now personally a phd in
genetic counseling.
Matt Burgess (15:34):
Look at, looking at what you looked at sounds way
more interesting than a phd indrosophila genetics.
However, I know that that wassomething that you nearly did.
Do you think, if you did aDrosophila Genetics PhD, that
you would have gone on and beena genetic counsellor and done
another PhD?
Laura Yeates (15:56):
Oh, I mean, I know there are some people in our
field who are like that I don'tthink I would have done a second
PhD.
I'm really glad I waited.
I think so, when I did myundergrad and honours year and
then I worked as a researchassistant in that lab that I did
my honours in in DrosophilaGenetics and then quit my job
(16:17):
and nicked off to Europe for afew months, as many people do,
and it was actually.
I gave myself the plane ridehome.
You know it's 20 hours.
I had to decide what I wasgoing to do with my life and the
three things were PhD, whichwould have had to be in
Drosophila, because that was myarea genetic counseling, or
trying to get into a lab-basedjob but doing human genetic
(16:38):
testing.
And so I got off the plane andI was like, nah, I want to do
genetic counseling, I don't know.
Like yeah, I think.
I think for me it just theappeal.
I realized once I did geneticcounseling that I liked
Drosophila genetics but I didn'tlove it.
Matt Burgess (16:55):
Whereas.
Laura Yeates (16:55):
I love genetics and genetic counseling, so it's
a bit like.
You know.
There's that great quote from10 things I had about you.
I like my Prada backpack.
No, I love my sketches, but Ilike whichever way.
But you know there is adifference between like and love
because I like my sketches.
But I love my Prada.
Matt Burgess (17:13):
That's yeah, you can cut that out beautiful, okay
, and one of the other parts ofyour PhD which you sort of
mentioned was the well-being ofgenetic counsellors and sort of
burnout and that sort of thing.
I know in our geneticcounselling courses we speak a
(17:36):
lot about self-care andself-compassion and sort of how
to look after ourselves and Iwas thinking about it the other
day because you know I sort ofdid my course around about the
same time as you did, which nowis a long time ago we're not
that old Matt, come on we're not, but it's like was a while ago.
(18:00):
Yeah, we're not aging, but youknow time is going ahead.
Oh, but yeah, what?
What did you find, and do youthink that our training is
enough to equip us with theskills that we need, or is it
sort of like an ongoing processthat it's, you know, genetic
counseling, self-care issomething that we need to be
(18:23):
mindful of all the time.
Laura Yeates (18:26):
Yeah, absolutely.
So I remember we did a lectureor two on self-care.
I remember people coming totalk and like great genetic
counsellors, like Ellie Lynch,came to talk to my class and I
still remember some of the tipsthat she gave me.
You know, and I think when Istarted I was really worried
about self-care.
So I very much you know I wouldchange my started.
I was really worried aboutself-care.
So I very much you know, Iwould change my outfit as soon
(18:47):
as I got home and take off mygenetic counselor and you know,
um, try and keep things separateand make sure I um I went along
to supervision all these things.
But I think as we get, as I gotfurther along, I know you get a
bit lax in some of thoseprotective behaviors and maybe
(19:08):
things don't affect you as muchas they did when you started as
well.
But it just takes sort of onefamily to hit a bit close to
home that you're like, oh okay,like something's got to give.
And I think in my researchthat's what I sort of found that
I had asked people who werespecifically in the area of
cardiac genetics because I wasinterested.
(19:28):
You know, not that it's acompetition but is particularly
sudden death, can be really hard.
Is that different or harder oreasier than other specialties?
And everyone sort of said, youknow there's some great quotes
in there, like everything we seeis a bit crap, you know, like
like to paraphrase, and so it'sall hard but nothing's really
(19:50):
harder or easier but ourskillset helps those families.
No matter what condition you'redealing with, it can still be
really horrible.
And so in that I think peoplein talking to in sorry, the
interviews and and I should saybecause I was a cardiac genetic
counselor, I didn't do theinterviews for that study we got
(20:11):
a genetic counselor who didn'twork in cardiac because you know
there aren't many of us, so Ididn't want to, we didn't.
We wanted them to feel likethey could chat freely.
But a lot of the interviewstalked about people trying
different things on, like fortheir self-care.
So going for a walk, debriefingwith a colleague, informally,
(20:31):
you know they had, like this,what we call a self-care toolkit
that they could sort of dip inand out of as needed, and a
theme sort of that came outthroughout is that even
throughout the career, how theyuse that toolkit changed and
what was in that toolkit changedbut they could re-evaluate and
go oh no, that kind of doesn'twork for me anymore.
(20:52):
I need something else, you know, and so I think it was just
this really beautiful picturethat that self-care is something
that needs to be an ongoingthing.
And so you know, just becauseyou're 20 years down the the
track or whatever we are, youknow not quite, but if we're 20
years practicing, we still needto look after our self-care.
(21:12):
Does it look different to whenwe were a new grad?
Probably absolutely, but, um,it's still really important.
Matt Burgess (21:20):
I know, like probably like five or six years
ago, I had been in the same jobfor about eight years.
A big part of my role wasseeing people or families for
cancer, genetic counselling, andthen another component was for
late onset neurologicalconditions like Huntington
disease and sort of testing forthat.
So, like you know, some prettybig areas.
(21:40):
But I felt as a senior geneticcounsellor that I was quite good
at being able to separate fromthat and, you know, leave that
at work and go home and and thatwas all fine.
And then I had my littlesojourn overseas and then in the
past year I've been working inprenatal and it's not something
(22:03):
or it's not an area that I'veworked in in a really long time
and I was actually thinkingabout sort of self-care and
burnout and, like the other dayI just had like three or four
high risk results or positiveresults in a row in one day and
I just thought, wow, I can'tremember the last time I've had
to do this and it's actuallyreally hard, like it made me,
(22:27):
like I sort of stopped and Ithought about it and you, know,
like I'm an empathic geneticcounselor and able to sort of do
that.
But I can't remember the lasttime when, um, yeah, like my
thoughts kind of stopped me andI like took a second to really
kind of think about oh, how am Ifeeling, like what is this
(22:49):
feeling that's coming up?
Oh, I am feeling something.
You know, this is difficult,and so I think that it's really
lovely that there areintelligent and empathic genetic
counsellors like yourself thatare doing research into this and
, you know, publishing andgiving advice and that sort of
thing.
Laura Yeates (23:10):
Yeah, oh, thanks.
That's nice for you to say andlike I think my team always pay
me out for us.
Like we joke about it, but it'sactually a serious question
when they've had, like you know,a harder call or whatever.
I'm seeing a few patients had aday like yours.
I asked them what are you goingto do to look after yourself
this evening?
Because often you know you cango on autopilot and you're a
(23:32):
professional.
We're good at like setting asideour stuff to focus on the
patient and give clients intocare, but then when you go home
and your guard goes down, that'swhen it can really hit home.
And so we I often ask thatquestion and now they ask it
back to me and it's quite funny.
So it's a bit of a joke but it'sa serious note because you know
(23:54):
we talked about in my researchthe importance of supervision,
and that might be groupsupervision, it might be one on
one, group supervision it mightbe one-on-one, but sometimes you
know you've had supervision twodays ago and now today's your
your three results in a row thatare going badly or something,
and so it's also about thinkingwhat, what do you do to bridge
(24:16):
until um bridge to supervision,or is it calling your supervisor
and having a chat a bit earlier?
You know, I think there's allthese things that we want to
just have in the back of ourmind and normalise so that you
know, particularly for the newgrads, that yeah, we've been in
this 20 years but stuff stillaffects us, because we're not
robots, right Like the chatbots,are never going to take our
(24:39):
jobs, we hope, because theycan't do like they're not a
person to be empathetic likethis, they can't do like they're
not a person to be empatheticlike this Exactly.
Matt Burgess (24:47):
And I know something else that is quite
helpful for me that you know, asa more junior genetic
counsellor I didn't quiterealise was sort of the
importance of attendingconferences, and not so much for
like the didactic side ofthings, but just I mean, I guess
maybe it could be to do withthe difference between
(25:08):
introverts and extroverts and meand you are both extroverted
people.
but I know that I do get, youknow, energized and recharged
when I go to conferences andit's the sort of the networking
or, you know, just catching upwith someone over coffee and
having a chat and that kind of Ifeel like that sort of you know
(25:32):
recharges my resilience levels,which then means that I can go
back into work and hopefullysort of maintain those positive
feelings.
I don't know if that's similarfor you.
Laura Yeates (25:47):
Yeah, I mean, I love going to the conference and
like HSA, our Australian AnnualGenetics Conference, but
particularly the AustralasianSociety of Genetic Council SIG
day before that is definitelyone of my favorites.
Yeah, I just, I think I reallylike it when we do practical
workshops and as scary as it isto try and practice things in
(26:07):
front of each other, like that'show you learn right.
Um, I have a bit of a saying Ilove to learn.
Like I think life gets boringif you stop learning.
So, whether that's, um, youknow, doing a PhD, whether it's
learning at a workshop, at aconference, whether it's joining
a new committee and learninghow to chair a meeting better,
or you know whatever it is, orhow to, how to do a strategic
(26:30):
plan, whatever it is, yeah, lifeis boring if you're not
learning.
in my opinion, but I'm also amassive extrovert so I just love
working the room at thosethings.
My team again say we don't seeyou at these conferences and I'm
like, well, no, I can talk toyou all the time.
I want to see all my GC peeps.
Matt Burgess (26:50):
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(27:31):
So you mentioned the ASGC.
So the Australasian Society ofGenetic Counselors, and you were
our chair for a number of years.
Laura Yeates (27:39):
How was that experience?
It was fantastic.
It was hard.
Again, it was through COVID, soI ended up doing so.
You start off as a deputy chair,you do a two years at deputy,
then you go two years chair, twoyears ex officio, so six year
commitment.
But when I was chair the personcoming after me was unable to
(28:03):
continue, which is for very goodreasons, and so I did an extra
year as chair than the normalrotation, so it was a seven year
commitment.
In the end I was pretty.
By the end of that seven yearsI was pretty tired Not I didn't,
not because I didn't love itParticularly the three years at
(28:23):
chair.
I really had a lot of fun andgot to work with some great
people, but it was also my PhDwas heating up and so I was
quite glad to hand over the ASGCexec to very capable people who
had come after me, so that wasgood.
I think what was really excitingabout when I became deputy is
(28:44):
the chairs before me, so thatwas good.
I think what was reallyexciting about when I became
deputy is the chairs before me.
So Vaman Chokka, alison McEwenhad worked really hard to sort
out genetic counsellorregistration in Australia.
Like that had been the focusfor many years of the ASGC and
also the board of censorsworking towards that.
And so when I came in, that waskind of done.
(29:06):
So it was kind of like, you know, I remember joining as deputy
and talking to Yvonne.
I'm like, well, what's next?
And he's like, yeah, what isnext?
We need a strategic plan.
And so, you know, this is whenwe started.
We implemented like the webinarseries and we finally got the
strategic plan up and running.
We did.
You know, the DICE workinggroup became a thing.
(29:29):
Like just all these reallygreat initiatives that are now
the three-minute thesis beingonline, like just really cool
things that I think are reallyimportant to our life as a
society are just yeah, I came inat the perfect time for me
because I like I could take us abit.
Um, you know I could.
(29:51):
I could take us in newdirection because we had the
breath space because of thepeople who'd been before me and
the hard work they'd done.
Matt Burgess (29:58):
Yeah, it's interesting to hear you say that
because you know, as someonewho was not on the executive
committee and who reads thenewsletter once a week, like
it's not obvious sort of all thework that's going on behind the
scenes.
So obviously you know justhearing that there was a
strategic plan that you put inplace and you were thinking
(30:20):
about what was needed, like it'slike oh, wow okay, I didn't
know about that.
Laura Yeates (30:25):
You need to read your newsletter, matt.
It was in there.
Um, look, that came towards theend in my time as ex-officio.
So, um, we definitely.
Um, it was something like ittook a long time to get going,
um, but it I think it's just ahelpful document to think about,
like what's next?
So it's a four-year strategicplan and so, because we are a
(30:47):
rolling executive, you know thenext person's got to come in.
We still want a focused, uh, Iguess vision for our society to
move forward.
So we want something consistent.
So we did consultancy, you know,lots of SWOT analysis with the
membership to try and work outwhere do we need to go, what's
next in in where we advocate,you know how, how do we provide
(31:12):
like, really good, appropriateCPD, like what, what are our
priorities and things?
So, yeah, it's, it's worthhaving a look it's.
Yeah, I mean that was a.
That was a busy time.
As I said, that came.
That was sort of my projectwhen I was ex officio, um, so,
once the chair position hadfinished, it was a nice thing to
be able to still be a part ofand and and see um to completion
(31:35):
.
Um, which was really nice.
And then, I guess, the otherthing that we did was the pilot
of our mentor program, um, whichwas, also, uh, you know,
something I'm really passionateabout Because, again, I have met
some genetic counselors in mycareer who are very kind and
take my call when I call them,but not maybe not everyone's
(31:55):
like that or feels like they cancomfortably say, just ring
someone up and go, oh yeah, Ineed some advice.
So we wanted to sort of do apilot program which we learned a
lot from, and so now we'retrying to, we're working with
the HSA um to try and build aprogram um and get them to help
us run it um.
(32:16):
We have lost a little bit ofsteam with that um just because
we're all volunteers and have alot on.
So it's something that's in theback of my mind to pick back up
it.
Matt Burgess (32:26):
It's lovely because you know there's maybe
between four and five hundredgenetic counsellors across
Australia and New Zealand thatare members of the um, the ASGC,
and talking about, you know,continuing professional
development and registration,like I think these are things
that make our society strongerand you know most, if not all,
(32:51):
genetic counselors are in therole to help people and um, but
it's just lovely and reassuringto know that we are trying as a
profession to have some sort ofguidelines or registration or,
you know, sort of rules that weabide by to make our society
(33:14):
stronger.
Laura Yeates (33:15):
Is that?
Matt Burgess (33:15):
sort of what like the ethos that people were
thinking about when they weretrying to put all of this
together, trying to put all ofthis together, I guess.
Laura Yeates (33:24):
So I mean registration has a few, I guess,
goals in that it keeps it.
Primarily it protects thepublic from harm.
If they're off to see a geneticcounsellor they can look them
up on the register and make surethat they have the appropriate
training to be providing thatservice, and that's really
(33:44):
important.
But I think it also just givesus credibility.
We're trying to apply forMedicare numbers so that our
time can be offered, can beMedicare-rebatable.
So at the moment, for instance,the cardiomyopathy genetic test
is, if you meet criteria, isavailable under Medicare, so no
(34:07):
cost to the patient and geneticcounselling is recommended as
part of that process.
It says by an appropriatelytrained person.
But who better to give geneticcounselling than a genetic
counsellor Like?
This is our bread and butter.
Yet doctors, like clinicalgeneticists, who do very good
work don't get me wrong they canbuild their time, but we can't
build ours and you know we allwork for services that have long
(34:31):
wait lists that areoverstretched.
If this, by allowing us to billfor our time, would open up
more money so we could hire moregenetic counsellors and
ultimately people don't have towait as long and have better
access to genetic testing.
I'm all for that on and havebetter access to genetic testing
.
Matt Burgess (34:48):
I'm all for that, said like a true public health
advocate.
I agree, yes, fingers crossed,it's not an easy process, but
let's keep chipping away at it.
But something else that you'repassionate about is
mainstreaming, and I know withsome of my other guests we've
sort of spoken about thisconcept of mainstreaming.
With some of my other guestswe've sort of spoken about this
(35:08):
concept of mainstreaming, but Iguess, in summary, mainstreaming
is the idea of genetic testing.
Instead of just being somethingthat is made available by
genetics healthcareprofessionals, so the genetic
counsellors and the genetics,it's sort of enabling or helping
other healthcare professionalsaccess genetic testing.
(35:30):
What has been your experienceof mainstreaming?
Laura Yeates (35:37):
Yeah well, so I guess I've mainly worked in a
mainstreaming kind like a hybridmainstreaming, I don't know
what you call it.
Instead of working as a geneticcounselor for a genetics
department who was then going tothe cardiac clinic, I was
employed through cardiology.
So I've I've kind of been inthis space for a while and so
(35:59):
you know I'm all formainstreaming.
Like people talk, they put alot about, you know, education
modules for doctors and nursesto be able to do, pre-consent
for genetic testing andconversations about results.
Like that is all great and goodand will help again, help
patients who can't currentlyaccess genetic testing in a
(36:20):
timely manner to access it.
But to me the simple solution isput a genetic counsellor in
each of those departments, likeI did.
Because actually what ends uphappening is that I work with
the cardiologists, I attend theMDTs and give the genetic
counselling input, I do journalclub on genetic conditions, I
(36:43):
upskill them just from being aparticipant, an active member of
staff and participant in theirdepartment, and then for the
easy stuff that they can do,they can do it.
But then I'm there for the hardstuff, when they're like I
don't know what to do here,laura, and you're like, okay,
like this is where I come in,you know.
So I think, um, whilst I am asupporter of mainstreaming
(37:06):
actually my ideal mainstreamingis put a genetic counselor in
every you know respiratory,nephrology, ophthalmology,
cardiology, all of thespecialties, neurology they're
already there.
But, um, what would happen ifwe flood each department with a
genetic counselor?
I think you'd see a bigincrease in understanding of
(37:27):
genetics and patients would getbetter care and there'd be more
jobs for genetic counsellors,because we do great work.
Matt Burgess (37:34):
That's my rant.
One of the most controversialthings I think we've ever heard
on this podcast.
Have genetic counsellors doingmainstreaming?
No, I completely agree.
I guess, like I don't know,seven or eight years ago in for
me, mainstreaming or what I wassort of exposed to was in
(37:54):
familial cancer, and you know,it went from a process where
every single person that washaving genetic testing for
cancer had to be seen ingenetics and then we soon
realized that it just can'tcontinue like that.
You know, this is not a modelthat we can maintain.
So we were trying to help ourcolleagues in other areas with
(38:20):
testing and I mean, it soundedlike an okay idea and I kind of
thought, oh, this is notdifficult.
But I, I guess, sort of comingback and and seeing what's
happened over the last six orseven years, it sort of
surprised me that it hasn't beenas successful as what I thought
it would be or could be.
(38:42):
And I think really the solution, which is basically exactly
what you just said, is put agenetic counsellor in there.
Like that would have sort ofhelped all of the issues, I
think.
Laura Yeates (38:56):
Yeah, because, as someone who knows what to do,
could brainstorm off to go.
Laura, I'm about to see thispatient.
I think this is what I'm goingto talk about.
If there's anything else, can Igrab you.
Or if they want to know aboutpre-implantation genetic
diagnosis, you know thecardiologist can sort of talk
about it as one sort of option,but it's like no, no, there are
(39:16):
three different options forfamily planning.
Like if you're going to bringup family planning, you need to
do it properly, like all thesethings that, yes, we can teach,
teach, but and I think, givingthat basic information, if some
people don't want to know allthe detail and they're just like
, oh, let's just do it, see whathappens and then think about it
once we get results, that'sfine.
(39:37):
But for those that have theextra questions, having the
person at the clinic, thegenetic counselor, who can
handle those extra questions andhe's trained to do the harder
questions is like it's all aboutputting us at our peak of scope
of practice, right?
Um, I have good skills, usethem, and let me use my skills
(39:57):
to train the rest of thedepartment in the same way.
You know, I I learn a lot abouthow to read an ecg and
echocardiogram.
Just by being in the MDTmeetings and asking questions,
you know.
When the electrophysiologistcardiologists are going on about
a Brigada pattern, I'm likewhat are you looking at?
Like teach me, and so now I canpick a Brigada pattern.
Like you know no cardiologist,but I can usually get a type one
(40:20):
and so you know.
It's that reciprocal learning,I think is really important.
I upskill, they upskill, andthen it's very much a team who
you know.
It's how we're meant to work.
This is our scope of practice,that's yours.
We work together for the bestcare that we can provide.
(40:40):
Like that's the dream, right?
Matt Burgess (40:43):
Yeah, just for the listeners that may not be au
fait with what MDTs are um, it'smultidisciplinary meetings and
I kind of think about what wasmedicine like before we had
these meetings, like it musthave just been so siloed did,
did people just write letters toeach other and it would take a
(41:05):
really long time.
But basically, you know, atthese MDT meetings all of the
cases for that particularindication are presented and all
of the different specialtiestalk about a particular case.
So I know for myself, I used tobe involved with the breast
cancer MDT.
So everyone who was diagnosedwith breast cancer that week we
(41:28):
would talk about it together.
There would be, you know, aradiologist, there'd be a
pathologist, there'd be asurgeon, a radiation therapist,
and it was a holistic way totalk about each case and sort of
work out what was best for thepatient.
But what was lovely was what isbest for the patient.
But what was lovely was what isbest for the patient is also to
have a genetic counsellorpresent and involved and
(41:51):
contributing to that.
So, um, you know, I I reallylike to hear that you are part
of a cardiac genetics MDT andtalking, you know, and that your
um role is really valued inthat sort of setting yeah, yeah,
a yeah 100%.
Laura Yeates (42:08):
And I think because it saves a lot of time
as well, right, because everyone, all those experts, are
weighing in on the plan for you,as you the patient, and even if
it's not, even if it's nextsteps, for you know, we need a
cardiac MRI to try and work outwhat this diagnosis is, and
we're ordering genetic testingand you know, I think also the
(42:29):
genetic counselor being there,where the person, if the patient
, has questions, they're goingto try and get them on the phone
, right, we're the ones you canget on the phone, you can't get
the doctors.
And so, having been a part ofthat conversation and just being
able to reiterate the plan, youknow, because, especially when
you go for an appointment, likeit's really hard, how much do
you actually take in a medicalappointment?
(42:49):
Having that plan, havingsomeone that you can call and
just kind of check things inwith, or like we'll send you an
email and go, oh, what was Imeant to do next, like and being
up to date with what's next?
I mean, it's kind of it's thechameleon of genetic counsellor,
right, like you could arguethat that's kind of going into a
nurse, coordinator or socialworker role.
So, again.
(43:09):
I think as my role in thecardiac clinic I kind of had a
wide, I kind of had to fill alot of gaps because we didn't
have a nurse but other clinicshave nurses who can, so you work
with that team, you know.
I just think it's a nice.
I think it just opens up a niceconversations and like if I I
had a medical problem, knowingthat six experts are in a room
(43:30):
to talk about me in a likeprofessional, like, not behind
the back way, but in a what'sthe best treatment for this
patient, I'm like, yeah, I'm allfor that right, because that's
sick.
It's not just one doctor, it'snow six experts in whatever
their area is who get to weighin on that.
Matt Burgess (43:46):
That's a yeah, you're going to get a better
answer now, I am someone whoquite likes a medical drama, um,
and in a lot of the sort of umdramas on tv they talk about
doing things, stat and you knowlike we need, um, you know,
information immediately and sortof one of the jokes in genetics
(44:08):
is nothing is ever really thaturgent.
You know, like in in emergency,if you need something straight
away, like seconds can make abig difference, whereas in
genetics, like really it's kindof like maybe days or, you know,
weeks or whatever.
But one of my um sort offavourite stories about you is
(44:28):
when you were requested by acardiologist because he needed a
genetics consult staff.
Can you tell us about that andsort of what happened and what
he needed you for?
Laura Yeates (44:42):
Yeah, sure.
So I mean I got a call to cometo the ward, which often
happened, you know, there'd be agenetic diagnosis or something
and they'd want me to come upand see the patient and give
them some education and helpsort out appointments or
organize genetic testing.
But this particular time one ofmy cardiologist colleagues, who
(45:04):
I knew she'd done some researchwith us, told me the story that
this cardiologist we had alovely patient and her family in
she was quite unwell, had comefrom overseas but couldn't, and
so didn't, speak much English,and so they were trying to take
a family history with theinterpreter, but there was
multiple consanguinity loops andso no one could work it out.
(45:26):
And so when I they're like'relike, oh, they need you to come,
like now, like right away, likeI think they're like we've
booked the, we've told theinterpreter to come back at like
12 o'clock, and it was like 11,15 or something, um, we need,
can you come at 12?
And and so I was like, yeah,yeah, I can come, um.
And so I got up there andthey'd managed to do that, that
this couple were married and hadsome children, and that was
(45:49):
about it.
So, I started again and itactually it was a hard.
It was a hard family tree.
You know it took me an hour anda half with the husband, um to,
and the interpreter, just tomake sure you know that we had
really got those relationshipsdown and there were multiple
consanguinity loops.
So I drew it up and put it inthe file, got those
relationships down and therewere multiple consanguinity
loops.
So I drew it up and put it inthe file.
But my colleague had told melater she was like I was
(46:10):
specifically asked that the youknow, the cardiologist kind of
yelled to the team.
Can someone please call LauraYates to come and take this
family history?
I don't know what's going on andso, like, at that point, you
know I had it's probably I, Idon't know, I was probably three
or four years into the job andso I'd worked really hard to
(46:31):
make sure I was at, you know,the weekly cardiology
departmental meetings I had anytime I was asked to consult on
the ward, or like one of thedoctors needed something, I
would try and do it straightaway, like really prioritize
them, like letting them know whoI was and the value that a
genetic counselor could have andhow I could help them.
(46:51):
And that was kind of when I knewI'm like, oh, if he's asking
for me, he knows what one, heknows what I can help with and
two, he values my input, yeah.
And so then we were joking thatlike I was needed stat.
It was very funny, it's likelike, and I kind of had to drop
everything no more clinic break,no, no, get up there and do it.
But it was just reallyvalidating for me that like, yes
(47:13):
, it had taken a long time togain this recognition, cause you
know, this is around like thiswould have been sort of 2010,.
2012 maybe.
So things were really startingto take off in in genetic text,
testing, wise and things.
So, yeah, it was just reallyvalidating for me that they
understood who I was and what Icould offer well done.
Matt Burgess (47:37):
I love that story, I think it's fantastic and but
it sort of highlights somethingas well.
You know, um in uh, our culturein Australia.
It's not often for some of usor most of us, when we're
drawing family trees to comeacross consanguinity and that's
the idea that our clients or thepeople that we're drawing on
(48:00):
the family tree may be relatedlike first cousins or second
cousins.
But I know sort of what makesit harder is when there are
multiple consanguineousrelationships in in the one
family tree.
It's like, oh okay, this iscomplicated and yeah, and just
trying to, you know, connect.
Laura Yeates (48:18):
So dad is your mom's, brother's, you know, like
, how, the, how the loop goes,because that's important just to
understand what might be goingon.
Genetically, um, each family isunique and I celebrate each and
every family that I talk about,like whether it's someone who
has, is adopted out and has nocontact, versus people who can
go six generations back.
(48:39):
Each family is unique and andbeautiful in whatever family
looks like for them.
Um, but, um, yeah, the, theconsanguinity loops.
It takes a little while to getright and it's important that we
get it right because we usethis information to assess risk.
Matt Burgess (48:53):
Yeah, and it's very interesting that you know
like one of the core sort ofcompetencies of a genetic
counsellor is drawing a familytree.
You know it's sort of you know,one of the the most basic or
one of the first things that welearn.
But it's interesting to thinkabout how it is a skill and that
(49:15):
we get better the more that wedo it.
And, um, I'm just curious, Idon't think I've seen one of
your hand-drawn pedigrees.
I know myself I'm not theneatest of people and what I
normally do is draw a familytree by hand and you know you
never know sort of where on thepage to put someone because
(49:37):
there might be more family andyou have to squash people in.
And then I sort of enjoy havingmy draft messy copy and then
doing a nice neat copy thatpeople can sort of read and
interpret, and whether that'sagain by hand or, you know,
using a program like TrackGene,who is a beautiful sponsor of
(49:58):
this podcast.
Thank you, trackgene.
Yeah, what do you think aboutsort of those basic genetic
counseling skills and sort ofthe importance of of?
Um, you know, practice and thatsort of thing?
Laura Yeates (50:11):
oh yeah, I mean, um, I, I am like you.
I draw a messy one and thenmake it presentable.
Um, because you're right, youalways put the person on the
wrong side of the page and thenthey've got like 10 siblings and
you put the other person withall this space who has like one
sibling.
You know it's crazy, um, Ithink for me, and something I
say a lot to the students and tothe new grads, is, you learn a
(50:36):
lot in your practice.
So I remember being in aconsult once with this lady who
we thought had arrhythmogenicright ventricular cardiomyopathy
, um ARVC, and I had taken herfamily history over the phone
before she came in.
And then she's in there withthe cardiologist and me and
we're giving her education aboutthe condition and she's like,
oh, after we got off the phone,I do have two siblings who died.
(50:58):
Did you need to know that?
And like, oh, they died intheir 30s.
And I was like I'm like yes, weneeded to know that.
And my boss looks at me likewhy?
Why am I paying you?
Like this is what, this is yourbread and butter.
And then I had reflected backand I clearly just didn't ask
the question in a way you know,I think I asked how many
siblings does she have?
(51:19):
But I didn't clarify wherethey're living or had passed
away or how many total werethere in your, how many children
were in your generation, inyour family.
And so you know from that it'slike okay, well, every pedigree
I did.
After that point I only madethat mistake once, right.
You then change your practiceand so I think you know you
learn something in the firsthundred pedigrees, the first 500
(51:40):
, the first thousand.
You can't rush that Like.
I feel like particularly andall due respect to the new
generation, they are lovely andthey have lots to teach me.
But one of the things I like toteach them is like don't try
and rush.
You know there's this urgencyto to get up the ranks and be
more senior genetic counselor.
Actually, you'll never have thegrace and the like, the support
(52:04):
in those early years again tolearn your craft and learn it
well.
So take that time, ask thequestions.
Don't be afraid that peoplethink you don't know because
you're a new grad, you're notmeant to know everything.
Just use that time and youcan't.
You know, I always say youcan't.
Just there's no shortcut to getto a thousand pedigrees.
(52:27):
You have to draw each and everyone, and so that practice will
change.
And then once you get to athousand, then we're going for
ten thousand.
But whatever it is, you know,just keep, that's okay, and
don't.
There is beauty in that and youlearn a lot from that process.
So don't, just, don't be tooquick to rush it.
I guess is my another one.
Matt Burgess (52:47):
Oh, I love your rants.
You sound so wise.
Oh, I don't know where thatcame from and I guess just
finally, you know thinking aboutstudents and a major theme in
genetic counselling iscertification, and you know we
have a certification processwhich is different to that in
(53:11):
the United States, which is moreof like a, a one-off exam,
which is different to what thegenetic counsellors do in the UK
.
What advice do you give um, youknow the the newer genetic
counsellors about certification?
Laura Yeates (53:35):
I say just do it Like yes, it's hard, it's hard
when you're working full time tothen be able to pull out your
computer on the weekend andwrite your cases.
But for me, it made me a bettergenetic counsellor.
Reflecting, working, looking atthe literature, what you know,
what theories can we use.
It made me a better geneticcounsellor, and I think genetic
counsellors um are the type buttend to be according to um
(53:58):
Robert Rester.
He wrote a blog post about howwe tend to be type A's.
So we, we want to do better, um, and so I think you know this
is part of it, and so I you knowmy advice is just break it down
, work.
Okay, I've got a couple ofhours now.
What am I going to work on?
I'll do my genetic section.
(54:19):
I'll do my transcribing of myrecorded case, whatever it is,
um, but just, although it's hard, enjoy the process because it
will make you better and weshould be better, because again,
it comes back to that wantingto keep learning.
Because you know when I started, the things that we do we do
now, like I can send for agenome testing.
(54:40):
Genome testing didn't exist whenI went through the course.
This is a profession.
If you don't like learning,you're in the wrong dog, because
the technology that we're goingto be using in 10 years hasn't
been invented yet.
Right, like so, um, yeah, Ijust think certification is a
particularly for your counselingskills is just a really
important process.
(55:01):
Um, so I, my biggest suggestionis to get a um, to get a like
good power ballad and just playthat on repeat.
Mine was Katy Perry raw andlike seriously, it got me
through.
Yeah, as I'm walking around,it's like, yeah, I've got this.
Like yeah, you're roaring, I'mroaring, yeah, especially when I
(55:24):
had to go in to do the umsession with the actor where the
board are watching.
Yeah, it's pretty intimidating.
I think they changed that now,but um, yeah, that was on repeat
for me oh good, I know I.
Matt Burgess (55:38):
You know Robert Rester's blogs and basically
everything he's written aboutgenetic counseling is amazing.
I am sort of the absoluteopposite of type A personality.
I'm very much type B, however,you know.
I guess we do in life, what'simportant to us or what gives us
(55:59):
meaning.
And I know I feel like a bignerd saying this, but I put so
much um importance on mycertification and it's still one
of the the proudest things I'vedone.
And I think on paper there areother things you know, like a
master's degree is probablyharder or better, or you know um
(56:22):
, than certification, but still,I still remember when I got my
letter saying you know,congratulations, you're now
board certified, like it was.
It was such an important moment.
So, yeah, I really hope thatthe newer genetic counselors
come that are coming throughsort of think about that and
appreciate that as well.
Laura Yeates (56:43):
Yeah, and it just.
It also just opens up aconversation.
Like you know, we would oftenpresent a case we were going to
write up in our supervisiongroup.
So then again you get moreinput.
You know, if you've got a fewgenetic counselors who've been
before you, would they read yourcase?
You know just ways that you canhelp get and you learn again.
You learn from the peoplewho've been before you and
(57:05):
sometimes and you can and thenhopefully you learn something
that you can apply to yourpractice.
Like I just think it's actually, although it's hard, is really
a valuable thing to do.
Excellent, it's easy to saythis side of it, it's like the
PhD.
You know, if you'd asked me thistime last year about a PhD,
when I was madly writing anddrowning, then yeah, you
(57:28):
might've got a different answer.
But this side of PhD, this sideof certification, life is good.
Matt Burgess (57:33):
Well, Dr Laura, thank you so much for chatting
to me about all things geneticsand genetic counseling.
I've really enjoyed it.
Laura Yeates (57:40):
My pleasure.
Thanks for all you do.
My name is Matt Burgess and I am a genetic
counsellor.
I am also the host of thispodcast, demystifying Genetics.
After finding my first geneticcounselling job and being in the
role for a few years, I beganthe process of board
certification.
I became certified by the HumanGenetic Society of Australasia
in genetic counselling 15 yearsago now.
(00:22):
Today's guest is Dr Laura Yates.
Laura is a cardiac geneticcounsellor based in Sydney who
has recently finished a PhD ingenetic counselling.
Join us for a greatconversation about certification
of genetic counsellors and lotsof other interesting topics.
And a big thank you to our mainsponsor, trackgene topics, and
(00:49):
a big thank you to our mainsponsor, trackgene.
Okay, hello, laura, and welcometo Demystifying Genetics.
Laura Yeates (00:51):
Hi, Matt, thanks for having me.
How are you?
Yeah?
Matt Burgess (00:54):
good, excellent.
Now, obviously I know you quitewell.
However, what I thought I couldask to start with is you know,
when you're like at a barbecueor a social function and you
meet like a friend of a friendand they say oh Laura what do
you do Like?
(01:14):
What's your sort of 90 secondsort of grab about what you do?
Laura Yeates (01:21):
Oh yeah, well, I love this question.
But I love I always say, well,I'm a genetic counsellor, and
then they pause and kind of lookat you If they haven't heard of
you, which most people haven't,they're like a what, a what?
Counsellor, and then I wouldsay I help families affected by
inherited disease and in my caseI've specialised in inherited
(01:43):
heart disease or cardiacconditions.
Matt Burgess (01:46):
Excellent yes, I remember.
Oh, I think I was like sick,like off sick from school, so
like maybe it was when I was inlike grade nine or ten or
something and Oprah was on and Iremember her talking about long
QT syndrome and I thought itwas fascinating.
And now I'm a geneticcounsellor, so I don't know if
(02:10):
there's any sort of link there,but You're here because of Oprah
.
Oh, so I have so manyinteresting things to talk to
you about, but maybe firstthings first.
Congratulations.
You have recently finished aPhD in genetic counselling.
How was the process and how areyou going now that you have
(02:32):
finished?
Laura Yeates (02:34):
Oh, I mean it was a great process.
It was kind of wild is a goodword for it.
I started my PhD in January of2020.
So things quickly changed witha global pandemic.
So I've heard some people saythat doing a PhD during COVID
would be way easier, but I don'tactually think it was.
(02:57):
Like others, I was trying toshare a kitchen table to do my
workday and taking conferencecalls in the backyard while we
were under lockdown and a coupleof my studies fell over because
we couldn't recruit.
While clinics weren't running,my primary supervisor moved to
institutes, which was a reallygreat thing, but just added
(03:17):
complications with gettingethics approval and extra
paperwork.
So there was a lot of stressfultimes in that, but also just
really joyous times.
Um, I really loved having timeto think and and deep dive, um
into like some of the literatureand just um, I did a lot of uh,
(03:38):
I did a bit of co-supervisingand master of genetic counseling
students during that time.
So was a student myself, butthen trying to also learn what's
the best way to get the bestout of your students in their
projects.
Yeah, I just had a great teambehind me and and yeah, I got to
do some great projects, bothwith families affected by sudden
(03:59):
cardiac death which is alwaysalways a privilege just for to
hear their stories and learnfrom them and got to do some
great work in well.
I think it's great, reallyfascinating work in genetic
counsellor wellbeing.
So that's also a passion ofmine.
Thinking about how do we makesure that we look after
(04:20):
ourselves so that we have a longand fruitful career is
something I'm really passionateabout.
So, yeah, it was crazy.
There were many times I didn'tthink I'd make it and I didn't
think I'd hand in, but I did andI've passed and it's all just
waiting to have my graduationceremony.
But yeah, I just had some.
I had the opportunitythroughout that it just opened a
(04:41):
lot of doors of different waysthat I could learn from
different people, not only mysupervisors but, um, just you
know, collaborators and otherresearchers and, um, uh, my
research participants as well.
Yeah, it's good.
Congratulations, that's a.
Matt Burgess (04:57):
It's a great achievement.
So tell me more about cardiacgenetics.
I know sort sort of you knowthat's a very broad and open
question, but I guess it's sortof similar to cancer when we
think of genetics.
A lot of cardiac conditions donot have a strong inherited
(05:19):
component, but then there arequite specific genetic diseases
or conditions where there is astrong genetic link.
So maybe if you could give thelisteners a little bit of an
overview of the different typesof conditions that you see, yeah
, sure.
Laura Yeates (05:35):
So I guess, to take a step back, like going
back, I trained in 2006,.
Right, I did the grad dip inMelbourne and then jobs were
really hard to come by.
But there was this job going inthe genetic heart disease
clinic at RPA, which I then gotand moved myself to Sydney and I
guess it was there that, like Ishould say, we did no cardiac
(06:01):
genetics in my training.
This is how new this field was.
Matt Burgess (06:04):
That was funny.
I I was just about to say howmany lectures did you do,
because I also did a one-yeargenetic counselling course and I
think I probably did a onetwo-hour cardiac genetics lesson
.
Laura Yeates (06:15):
Yeah, no, I mean I was lucky enough I'd started
applying for jobs quite earlybecause I was quite worried that
I wouldn't get a job, as wasthe state of play back in the
2000s, and then I landed the jobup in Sydney and then my final
placement was with Ivan Machokain Melbourne who was a cardiac
(06:35):
genetic counsellor, and so Ithink through my four week
placement we had maybe onecardiac clinic, and so I was
likeonne, you need to teach meeverything you know.
He was very gracious and so,yeah, I learned as much as I
could from him in a very smallamount of time and then moved up
to Sydney.
So the conditions that wefocused on at RPA were the
(06:57):
inherited cardiomyopathy, so theinherited muscle problems,
heart muscle problems, sothickening of the heart or when
the heart gets big and baggy.
We also focus on the inheritedarrhythmias, so in those the
heart is a normal size butthere's rhythm problems of the
heart like long QT syndrome.
There are lots of other heart,familial heart conditions, like
(07:19):
what we call aortopathies orconditions of the aorta but
there was a separate clinic atRPA for those, so I didn't see
those and also the same withfamilial high cholesterol, which
can cause early coronary arterydisease.
So, again, a separatespecialist clinic for those, and
so, yeah, my focus was verymuch on the inherited
(07:40):
cardiomyopathies, the inheritedarrhythmias, the inherited
cardiomyopathies, the inheritedarrhythmias.
And then we also had aspecialist focus on caring for
families who have had a youngperson pass away suddenly, and
often it's the firstpresentation of disease, so the
family have no idea that there'sthis heart condition in their
family and then someone justdrops dead, and so it's a pretty
(08:02):
horrible time just drops deadand so it's a pretty horrible
time.
Matt Burgess (08:08):
I think obviously there are many different areas
of clinical genetics, but whenwe think about cardiac genetics,
you know it's quite common thatwe see families where there is
sudden cardiac death.
And just to think about howdevastating that must be to not
even know that there's a geneticcondition and then a loved one
passes away so suddenly andunexpectedly, you know,
(08:29):
sometimes at a really young ageand then to realise that maybe
other people in the family arealso at risk of this, like it's
just incredibly difficult.
Laura Yeates (08:39):
Yeah, 100%, 100%.
Matt Burgess (08:41):
So in your PhD, 100%, 100%.
So in your PhD, how did thecardiac genetics come into it?
Because I think you were sortof involved with looking at the
families and how the familiessort of come into it.
Is that right?
Laura Yeates (08:57):
Yeah, I mean we had, so I'd worked.
I worked in the prior to my PhD.
I'd worked full time in thecardiac genetic clinic for I
think it was about 12 years, andat that point I was, I guess,
looking for a new challenge.
You'll find about me I don'tsit still very well.
I, yeah, I needed to stretchmyself a bit more.
(09:17):
I was also a bit tired, neededa change of pace, and so was
thinking about what was next.
Like, did I want to move into adifferent?
area of genetics, I had alwaysthought about doing a PhD.
And then the Heart Foundationhad some.
They had opened up theirscholarships from just offering
(09:38):
PhD scholarships tocardiologists.
They'd opened them up to alliedhealth as well, and so I
thought, well, this is going togoing to be my best chance.
You know, doing your PhD laterin life and going back to a
student budget is quite hard,but these are quite generous
scholarships and so this waskind of going to be my best
chance.
And also, I had just, I think,seen these families and we we,
(10:01):
you know over.
So the clinic I work in, orworked in, had a really strong
clinical and research focus.
So, working with other geneticcounselors, like Jodie Ingalls,
we had really described and seena lot of, I guess, ask
questions of our patients aboutwhat it's like to lose someone
(10:21):
suddenly.
And actually, you know, a paperthat I did in 2013 as part of
my certification talked aboutthe psychosocial impact on
families and just how theydidn't cope very well, and
mothers particularly didn't cope, and so we had sort of measured
this.
We did a needs analysis and thefamilies were telling us we
need more support and we needmore information, and so I was
(10:45):
like, well, I can keep sayinghow there's a problem and the
system's broken, or I can do aPhD and try and find some a
solution, and so that's what Idid.
So my PhD focused on Ico-designed with focus groups a
support intervention forfamilies affected by sudden
cardiac death, and so from thosefocus groups, they told us they
(11:07):
wanted an avenue for peersupport and they wanted more
information.
And then some of our other work.
They had also talked about justwanting someone, almost like a
caseworker or something to takethem through the process after
sudden cardiac death.
And so you know I can come backto that a bit later about what
(11:28):
we're doing post-PhD, but that'sa real focus.
But for my PhD, we then, afterthe focus groups, went about
developing a website and someonline support sessions based on
the feedback from those focusgroups.
And then I measure.
So I wrote all the content forboth parts of the intervention
and then assessed theacceptability.
(11:49):
So, like before I did my PhD,I'm like, oh, something's
acceptable or it's notacceptable, but it turns out
it's more complicated than that.
So, yeah, I used a theoreticalframework of acceptability just
to to look at seven different umareas or constructs of
acceptability and, uh, to makesure that the intervention we
(12:10):
developed was acceptable tofamilies, which was excellent,
and I guess you know when wethink about um research.
Matt Burgess (12:21):
Um sorry, my dog has just come home I'm gonna
close the door there.
When we think of research.
Uh, you know you can gatherdata in like a quantitative way
and sort of like, um, ask peoplequestions and get them to sort
of jot down answers and and youknow numbers and sort of short
(12:42):
answers, but then you can alsosort of talk to people and you
know that's more of aqualitative sort of approach.
What is sort of the approachthat you took and is that sort
of what you enjoy doing?
Laura Yeates (13:01):
Yeah, I took a mainly qualitative approach and,
yes, I I'm a massive talker, asyou can tell, but I just love
hearing uh people's stories andI think there's a lot to learn
just from people's experienceand um, you know, just asking
the right or probing questionscan just tell you a lot about um
(13:23):
, about either what it's like tolive in a family where
someone's died or live with aninherited heart condition, um,
or my, you know, my otherproject of my phd was about
genetic health, a geneticcounselor, well-being, so how,
as practitioners, we maintainwell-being.
So, asking about thatexperience and hearing what
works for some GCs and not forothers, um, yeah, I just think
(13:47):
there's a lot of power instorytelling um, you know, and I
think of uh IndigenousAustralians and their traditions
of storytelling as just areally beautiful um way to pass
on wisdom to the next generationand um and learn.
Yeah, I've always liked a bitof qualm, yeah, but mainly
(14:10):
because I just love talking topeople and hearing from them and
their story.
Matt Burgess (14:15):
I think I'm exactly the same.
I really like qualitativeresearch, where you know you
kind of come up with an idea andthen you can sort of do a deep
dive with people and ask themquestions.
And then what was sort ofsurprising for me was when I
came time to sort of code andanalyze and I don't know in my
(14:36):
mind I thought, oh, that's a bitsort of analytical and I don't
like that, but I actually reallyenjoyed it.
Laura Yeates (14:40):
It's like, oh, you know, these people kind of said
, oh, you know, this is sort ofsimilar here, or you know, lots
of people sort of said the samething and that surprised me and
yeah, I really quite like thatsort of side of qualitative
research yeah, and and how youknow, around a central point
there can actually be quite avast area of you know of of
(15:02):
opinion, and that that's okay,you know, like that's just the
spectrum of opinion withinwhatever issue that you're
talking about is also justreally fascinating.
Even though these people mighthave the exact same disease and
have had a similar course of ofdisease in their life, similar
impact, they can have verydifferent interpretations of
(15:24):
that on their own life and yeahyou know that's to be celebrated
um the variety that comes inthat now personally a phd in
genetic counseling.
Matt Burgess (15:34):
Look at, looking at what you looked at sounds way
more interesting than a phd indrosophila genetics.
However, I know that that wassomething that you nearly did.
Do you think, if you did aDrosophila Genetics PhD, that
you would have gone on and beena genetic counsellor and done
another PhD?
Laura Yeates (15:56):
Oh, I mean, I know there are some people in our
field who are like that I don'tthink I would have done a second
PhD.
I'm really glad I waited.
I think so, when I did myundergrad and honours year and
then I worked as a researchassistant in that lab that I did
my honours in in DrosophilaGenetics and then quit my job
(16:17):
and nicked off to Europe for afew months, as many people do,
and it was actually.
I gave myself the plane ridehome.
You know it's 20 hours.
I had to decide what I wasgoing to do with my life and the
three things were PhD, whichwould have had to be in
Drosophila, because that was myarea genetic counseling, or
trying to get into a lab-basedjob but doing human genetic
(16:38):
testing.
And so I got off the plane andI was like, nah, I want to do
genetic counseling, I don't know.
Like yeah, I think.
I think for me it just theappeal.
I realized once I did geneticcounseling that I liked
Drosophila genetics but I didn'tlove it.
Matt Burgess (16:55):
Whereas.
Laura Yeates (16:55):
I love genetics and genetic counseling, so it's
a bit like.
You know.
There's that great quote from10 things I had about you.
I like my Prada backpack.
No, I love my sketches, but Ilike whichever way.
But you know there is adifference between like and love
because I like my sketches.
But I love my Prada.
Matt Burgess (17:13):
That's yeah, you can cut that out beautiful, okay
, and one of the other parts ofyour PhD which you sort of
mentioned was the well-being ofgenetic counsellors and sort of
burnout and that sort of thing.
I know in our geneticcounselling courses we speak a
(17:36):
lot about self-care andself-compassion and sort of how
to look after ourselves and Iwas thinking about it the other
day because you know I sort ofdid my course around about the
same time as you did, which nowis a long time ago we're not
that old Matt, come on we're not, but it's like was a while ago.
(18:00):
Yeah, we're not aging, but youknow time is going ahead.
Oh, but yeah, what?
What did you find, and do youthink that our training is
enough to equip us with theskills that we need, or is it
sort of like an ongoing processthat it's, you know, genetic
counseling, self-care issomething that we need to be
(18:23):
mindful of all the time.
Laura Yeates (18:26):
Yeah, absolutely.
So I remember we did a lectureor two on self-care.
I remember people coming totalk and like great genetic
counsellors, like Ellie Lynch,came to talk to my class and I
still remember some of the tipsthat she gave me.
You know, and I think when Istarted I was really worried
about self-care.
So I very much you know I wouldchange my started.
I was really worried aboutself-care.
So I very much you know, Iwould change my outfit as soon
(18:47):
as I got home and take off mygenetic counselor and you know,
um, try and keep things separateand make sure I um I went along
to supervision all these things.
But I think as we get, as I gotfurther along, I know you get a
bit lax in some of thoseprotective behaviors and maybe
(19:08):
things don't affect you as muchas they did when you started as
well.
But it just takes sort of onefamily to hit a bit close to
home that you're like, oh okay,like something's got to give.
And I think in my researchthat's what I sort of found that
I had asked people who werespecifically in the area of
cardiac genetics because I wasinterested.
(19:28):
You know, not that it's acompetition but is particularly
sudden death, can be really hard.
Is that different or harder oreasier than other specialties?
And everyone sort of said, youknow there's some great quotes
in there, like everything we seeis a bit crap, you know, like
like to paraphrase, and so it'sall hard but nothing's really
(19:50):
harder or easier but ourskillset helps those families.
No matter what condition you'redealing with, it can still be
really horrible.
And so in that I think peoplein talking to in sorry, the
interviews and and I should saybecause I was a cardiac genetic
counselor, I didn't do theinterviews for that study we got
(20:11):
a genetic counselor who didn'twork in cardiac because you know
there aren't many of us, so Ididn't want to, we didn't.
We wanted them to feel likethey could chat freely.
But a lot of the interviewstalked about people trying
different things on, like fortheir self-care.
So going for a walk, debriefingwith a colleague, informally,
(20:31):
you know they had, like this,what we call a self-care toolkit
that they could sort of dip inand out of as needed, and a
theme sort of that came outthroughout is that even
throughout the career, how theyuse that toolkit changed and
what was in that toolkit changedbut they could re-evaluate and
go oh no, that kind of doesn'twork for me anymore.
(20:52):
I need something else, you know, and so I think it was just
this really beautiful picturethat that self-care is something
that needs to be an ongoingthing.
And so you know, just becauseyou're 20 years down the the
track or whatever we are, youknow not quite, but if we're 20
years practicing, we still needto look after our self-care.
(21:12):
Does it look different to whenwe were a new grad?
Probably absolutely, but, um,it's still really important.
Matt Burgess (21:20):
I know, like probably like five or six years
ago, I had been in the same jobfor about eight years.
A big part of my role wasseeing people or families for
cancer, genetic counselling, andthen another component was for
late onset neurologicalconditions like Huntington
disease and sort of testing forthat.
So, like you know, some prettybig areas.
(21:40):
But I felt as a senior geneticcounsellor that I was quite good
at being able to separate fromthat and, you know, leave that
at work and go home and and thatwas all fine.
And then I had my littlesojourn overseas and then in the
past year I've been working inprenatal and it's not something
(22:03):
or it's not an area that I'veworked in in a really long time
and I was actually thinkingabout sort of self-care and
burnout and, like the other dayI just had like three or four
high risk results or positiveresults in a row in one day and
I just thought, wow, I can'tremember the last time I've had
to do this and it's actuallyreally hard, like it made me,
(22:27):
like I sort of stopped and Ithought about it and you, know,
like I'm an empathic geneticcounselor and able to sort of do
that.
But I can't remember the lasttime when, um, yeah, like my
thoughts kind of stopped me andI like took a second to really
kind of think about oh, how am Ifeeling, like what is this
(22:49):
feeling that's coming up?
Oh, I am feeling something.
You know, this is difficult,and so I think that it's really
lovely that there areintelligent and empathic genetic
counsellors like yourself thatare doing research into this and
, you know, publishing andgiving advice and that sort of
thing.
Laura Yeates (23:10):
Yeah, oh, thanks.
That's nice for you to say andlike I think my team always pay
me out for us.
Like we joke about it, but it'sactually a serious question
when they've had, like you know,a harder call or whatever.
I'm seeing a few patients had aday like yours.
I asked them what are you goingto do to look after yourself
this evening?
Because often you know you cango on autopilot and you're a
(23:32):
professional.
We're good at like setting asideour stuff to focus on the
patient and give clients intocare, but then when you go home
and your guard goes down, that'swhen it can really hit home.
And so we I often ask thatquestion and now they ask it
back to me and it's quite funny.
So it's a bit of a joke but it'sa serious note because you know
(23:54):
we talked about in my researchthe importance of supervision,
and that might be groupsupervision, it might be one on
one, group supervision it mightbe one-on-one, but sometimes you
know you've had supervision twodays ago and now today's your
your three results in a row thatare going badly or something,
and so it's also about thinkingwhat, what do you do to bridge
(24:16):
until um bridge to supervision,or is it calling your supervisor
and having a chat a bit earlier?
You know, I think there's allthese things that we want to
just have in the back of ourmind and normalise so that you
know, particularly for the newgrads, that yeah, we've been in
this 20 years but stuff stillaffects us, because we're not
robots, right Like the chatbots,are never going to take our
(24:39):
jobs, we hope, because theycan't do like they're not a
person to be empathetic likethis, they can't do like they're
not a person to be empatheticlike this Exactly.
Matt Burgess (24:47):
And I know something else that is quite
helpful for me that you know, asa more junior genetic
counsellor I didn't quiterealise was sort of the
importance of attendingconferences, and not so much for
like the didactic side ofthings, but just I mean, I guess
maybe it could be to do withthe difference between
(25:08):
introverts and extroverts and meand you are both extroverted
people.
but I know that I do get, youknow, energized and recharged
when I go to conferences andit's the sort of the networking
or, you know, just catching upwith someone over coffee and
having a chat and that kind of Ifeel like that sort of you know
(25:32):
recharges my resilience levels,which then means that I can go
back into work and hopefullysort of maintain those positive
feelings.
I don't know if that's similarfor you.
Laura Yeates (25:47):
Yeah, I mean, I love going to the conference and
like HSA, our Australian AnnualGenetics Conference, but
particularly the AustralasianSociety of Genetic Council SIG
day before that is definitelyone of my favorites.
Yeah, I just, I think I reallylike it when we do practical
workshops and as scary as it isto try and practice things in
(26:07):
front of each other, like that'show you learn right.
Um, I have a bit of a saying Ilove to learn.
Like I think life gets boringif you stop learning.
So, whether that's, um, youknow, doing a PhD, whether it's
learning at a workshop, at aconference, whether it's joining
a new committee and learninghow to chair a meeting better,
or you know whatever it is, orhow to, how to do a strategic
(26:30):
plan, whatever it is, yeah, lifeis boring if you're not
learning.
in my opinion, but I'm also amassive extrovert so I just love
working the room at thosethings.
My team again say we don't seeyou at these conferences and I'm
like, well, no, I can talk toyou all the time.
I want to see all my GC peeps.
Matt Burgess (26:50):
I feel like I'm exactly the same.
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(27:31):
So you mentioned the ASGC.
So the Australasian Society ofGenetic Counselors, and you were
our chair for a number of years.
Laura Yeates (27:39):
How was that experience?
It was fantastic.
It was hard.
Again, it was through COVID, soI ended up doing so.
You start off as a deputy chair,you do a two years at deputy,
then you go two years chair, twoyears ex officio, so six year
commitment.
But when I was chair the personcoming after me was unable to
(28:03):
continue, which is for very goodreasons, and so I did an extra
year as chair than the normalrotation, so it was a seven year
commitment.
In the end I was pretty.
By the end of that seven yearsI was pretty tired Not I didn't,
not because I didn't love itParticularly the three years at
(28:23):
chair.
I really had a lot of fun andgot to work with some great
people, but it was also my PhDwas heating up and so I was
quite glad to hand over the ASGCexec to very capable people who
had come after me, so that wasgood.
I think what was really excitingabout when I became deputy is
(28:44):
the chairs before me, so thatwas good.
I think what was reallyexciting about when I became
deputy is the chairs before me.
So Vaman Chokka, alison McEwenhad worked really hard to sort
out genetic counsellorregistration in Australia.
Like that had been the focusfor many years of the ASGC and
also the board of censorsworking towards that.
And so when I came in, that waskind of done.
(29:06):
So it was kind of like, you know, I remember joining as deputy
and talking to Yvonne.
I'm like, well, what's next?
And he's like, yeah, what isnext?
We need a strategic plan.
And so, you know, this is whenwe started.
We implemented like the webinarseries and we finally got the
strategic plan up and running.
We did.
You know, the DICE workinggroup became a thing.
(29:29):
Like just all these reallygreat initiatives that are now
the three-minute thesis beingonline, like just really cool
things that I think are reallyimportant to our life as a
society are just yeah, I came inat the perfect time for me
because I like I could take us abit.
Um, you know I could.
(29:51):
I could take us in newdirection because we had the
breath space because of thepeople who'd been before me and
the hard work they'd done.
Matt Burgess (29:58):
Yeah, it's interesting to hear you say that
because you know, as someonewho was not on the executive
committee and who reads thenewsletter once a week, like
it's not obvious sort of all thework that's going on behind the
scenes.
So obviously you know justhearing that there was a
strategic plan that you put inplace and you were thinking
(30:20):
about what was needed, like it'slike oh, wow okay, I didn't
know about that.
Laura Yeates (30:25):
You need to read your newsletter, matt.
It was in there.
Um, look, that came towards theend in my time as ex-officio.
So, um, we definitely.
Um, it was something like ittook a long time to get going,
um, but it I think it's just ahelpful document to think about,
like what's next?
So it's a four-year strategicplan and so, because we are a
(30:47):
rolling executive, you know thenext person's got to come in.
We still want a focused, uh, Iguess vision for our society to
move forward.
So we want something consistent.
So we did consultancy, you know,lots of SWOT analysis with the
membership to try and work outwhere do we need to go, what's
next in in where we advocate,you know how, how do we provide
(31:12):
like, really good, appropriateCPD, like what, what are our
priorities and things?
So, yeah, it's, it's worthhaving a look it's.
Yeah, I mean that was a.
That was a busy time.
As I said, that came.
That was sort of my projectwhen I was ex officio, um, so,
once the chair position hadfinished, it was a nice thing to
be able to still be a part ofand and and see um to completion
(31:35):
.
Um, which was really nice.
And then, I guess, the otherthing that we did was the pilot
of our mentor program, um, whichwas, also, uh, you know,
something I'm really passionateabout Because, again, I have met
some genetic counselors in mycareer who are very kind and
take my call when I call them,but not maybe not everyone's
(31:55):
like that or feels like they cancomfortably say, just ring
someone up and go, oh yeah, Ineed some advice.
So we wanted to sort of do apilot program which we learned a
lot from, and so now we'retrying to, we're working with
the HSA um to try and build aprogram um and get them to help
us run it um.
(32:16):
We have lost a little bit ofsteam with that um just because
we're all volunteers and have alot on.
So it's something that's in theback of my mind to pick back up
it.
Matt Burgess (32:26):
It's lovely because you know there's maybe
between four and five hundredgenetic counsellors across
Australia and New Zealand thatare members of the um, the ASGC,
and talking about, you know,continuing professional
development and registration,like I think these are things
that make our society strongerand you know most, if not all,
(32:51):
genetic counselors are in therole to help people and um, but
it's just lovely and reassuringto know that we are trying as a
profession to have some sort ofguidelines or registration or,
you know, sort of rules that weabide by to make our society
(33:14):
stronger.
Laura Yeates (33:15):
Is that?
Matt Burgess (33:15):
sort of what like the ethos that people were
thinking about when they weretrying to put all of this
together, trying to put all ofthis together, I guess.
Laura Yeates (33:24):
So I mean registration has a few, I guess,
goals in that it keeps it.
Primarily it protects thepublic from harm.
If they're off to see a geneticcounsellor they can look them
up on the register and make surethat they have the appropriate
training to be providing thatservice, and that's really
(33:44):
important.
But I think it also just givesus credibility.
We're trying to apply forMedicare numbers so that our
time can be offered, can beMedicare-rebatable.
So at the moment, for instance,the cardiomyopathy genetic test
is, if you meet criteria, isavailable under Medicare, so no
(34:07):
cost to the patient and geneticcounselling is recommended as
part of that process.
It says by an appropriatelytrained person.
But who better to give geneticcounselling than a genetic
counsellor Like?
This is our bread and butter.
Yet doctors, like clinicalgeneticists, who do very good
work don't get me wrong they canbuild their time, but we can't
build ours and you know we allwork for services that have long
(34:31):
wait lists that areoverstretched.
If this, by allowing us to billfor our time, would open up
more money so we could hire moregenetic counsellors and
ultimately people don't have towait as long and have better
access to genetic testing.
I'm all for that on and havebetter access to genetic testing
.
Matt Burgess (34:48):
I'm all for that, said like a true public health
advocate.
I agree, yes, fingers crossed,it's not an easy process, but
let's keep chipping away at it.
But something else that you'repassionate about is
mainstreaming, and I know withsome of my other guests we've
sort of spoken about thisconcept of mainstreaming.
With some of my other guestswe've sort of spoken about this
(35:08):
concept of mainstreaming, but Iguess, in summary, mainstreaming
is the idea of genetic testing.
Instead of just being somethingthat is made available by
genetics healthcareprofessionals, so the genetic
counsellors and the genetics,it's sort of enabling or helping
other healthcare professionalsaccess genetic testing.
(35:30):
What has been your experienceof mainstreaming?
Laura Yeates (35:37):
Yeah well, so I guess I've mainly worked in a
mainstreaming kind like a hybridmainstreaming, I don't know
what you call it.
Instead of working as a geneticcounselor for a genetics
department who was then going tothe cardiac clinic, I was
employed through cardiology.
So I've I've kind of been inthis space for a while and so
(35:59):
you know I'm all formainstreaming.
Like people talk, they put alot about, you know, education
modules for doctors and nursesto be able to do, pre-consent
for genetic testing andconversations about results.
Like that is all great and goodand will help again, help
patients who can't currentlyaccess genetic testing in a
(36:20):
timely manner to access it.
But to me the simple solution isput a genetic counsellor in
each of those departments, likeI did.
Because actually what ends uphappening is that I work with
the cardiologists, I attend theMDTs and give the genetic
counselling input, I do journalclub on genetic conditions, I
(36:43):
upskill them just from being aparticipant, an active member of
staff and participant in theirdepartment, and then for the
easy stuff that they can do,they can do it.
But then I'm there for the hardstuff, when they're like I
don't know what to do here,laura, and you're like, okay,
like this is where I come in,you know.
So I think, um, whilst I am asupporter of mainstreaming
(37:06):
actually my ideal mainstreamingis put a genetic counselor in
every you know respiratory,nephrology, ophthalmology,
cardiology, all of thespecialties, neurology they're
already there.
But, um, what would happen ifwe flood each department with a
genetic counselor?
I think you'd see a bigincrease in understanding of
(37:27):
genetics and patients would getbetter care and there'd be more
jobs for genetic counsellors,because we do great work.
Matt Burgess (37:34):
That's my rant.
One of the most controversialthings I think we've ever heard
on this podcast.
Have genetic counsellors doingmainstreaming?
No, I completely agree.
I guess, like I don't know,seven or eight years ago in for
me, mainstreaming or what I wassort of exposed to was in
(37:54):
familial cancer, and you know,it went from a process where
every single person that washaving genetic testing for
cancer had to be seen ingenetics and then we soon
realized that it just can'tcontinue like that.
You know, this is not a modelthat we can maintain.
So we were trying to help ourcolleagues in other areas with
(38:20):
testing and I mean, it soundedlike an okay idea and I kind of
thought, oh, this is notdifficult.
But I, I guess, sort of comingback and and seeing what's
happened over the last six orseven years, it sort of
surprised me that it hasn't beenas successful as what I thought
it would be or could be.
(38:42):
And I think really the solution, which is basically exactly
what you just said, is put agenetic counsellor in there.
Like that would have sort ofhelped all of the issues, I
think.
Laura Yeates (38:56):
Yeah, because, as someone who knows what to do,
could brainstorm off to go.
Laura, I'm about to see thispatient.
I think this is what I'm goingto talk about.
If there's anything else, can Igrab you.
Or if they want to know aboutpre-implantation genetic
diagnosis, you know thecardiologist can sort of talk
about it as one sort of option,but it's like no, no, there are
(39:16):
three different options forfamily planning.
Like if you're going to bringup family planning, you need to
do it properly, like all thesethings that, yes, we can teach,
teach, but and I think, givingthat basic information, if some
people don't want to know allthe detail and they're just like
, oh, let's just do it, see whathappens and then think about it
once we get results, that'sfine.
(39:37):
But for those that have theextra questions, having the
person at the clinic, thegenetic counselor, who can
handle those extra questions andhe's trained to do the harder
questions is like it's all aboutputting us at our peak of scope
of practice, right?
Um, I have good skills, usethem, and let me use my skills
(39:57):
to train the rest of thedepartment in the same way.
You know, I I learn a lot abouthow to read an ecg and
echocardiogram.
Just by being in the MDTmeetings and asking questions,
you know.
When the electrophysiologistcardiologists are going on about
a Brigada pattern, I'm likewhat are you looking at?
Like teach me, and so now I canpick a Brigada pattern.
Like you know no cardiologist,but I can usually get a type one
(40:20):
and so you know.
It's that reciprocal learning,I think is really important.
I upskill, they upskill, andthen it's very much a team who
you know.
It's how we're meant to work.
This is our scope of practice,that's yours.
We work together for the bestcare that we can provide.
(40:40):
Like that's the dream, right?
Matt Burgess (40:43):
Yeah, just for the listeners that may not be au
fait with what MDTs are um, it'smultidisciplinary meetings and
I kind of think about what wasmedicine like before we had
these meetings, like it musthave just been so siloed did,
did people just write letters toeach other and it would take a
(41:05):
really long time.
But basically, you know, atthese MDT meetings all of the
cases for that particularindication are presented and all
of the different specialtiestalk about a particular case.
So I know for myself, I used tobe involved with the breast
cancer MDT.
So everyone who was diagnosedwith breast cancer that week we
(41:28):
would talk about it together.
There would be, you know, aradiologist, there'd be a
pathologist, there'd be asurgeon, a radiation therapist,
and it was a holistic way totalk about each case and sort of
work out what was best for thepatient.
But what was lovely was what isbest for the patient.
But what was lovely was what isbest for the patient is also to
have a genetic counsellorpresent and involved and
(41:51):
contributing to that.
So, um, you know, I I reallylike to hear that you are part
of a cardiac genetics MDT andtalking, you know, and that your
um role is really valued inthat sort of setting yeah, yeah,
a yeah 100%.
Laura Yeates (42:08):
And I think because it saves a lot of time
as well, right, because everyone, all those experts, are
weighing in on the plan for you,as you the patient, and even if
it's not, even if it's nextsteps, for you know, we need a
cardiac MRI to try and work outwhat this diagnosis is, and
we're ordering genetic testingand you know, I think also the
(42:29):
genetic counselor being there,where the person, if the patient
, has questions, they're goingto try and get them on the phone
, right, we're the ones you canget on the phone, you can't get
the doctors.
And so, having been a part ofthat conversation and just being
able to reiterate the plan, youknow, because, especially when
you go for an appointment, likeit's really hard, how much do
you actually take in a medicalappointment?
(42:49):
Having that plan, havingsomeone that you can call and
just kind of check things inwith, or like we'll send you an
email and go, oh, what was Imeant to do next, like and being
up to date with what's next?
I mean, it's kind of it's thechameleon of genetic counsellor,
right, like you could arguethat that's kind of going into a
nurse, coordinator or socialworker role.
So, again.
(43:09):
I think as my role in thecardiac clinic I kind of had a
wide, I kind of had to fill alot of gaps because we didn't
have a nurse but other clinicshave nurses who can, so you work
with that team, you know.
I just think it's a nice.
I think it just opens up a niceconversations and like if I I
had a medical problem, knowingthat six experts are in a room
(43:30):
to talk about me in a likeprofessional, like, not behind
the back way, but in a what'sthe best treatment for this
patient, I'm like, yeah, I'm allfor that right, because that's
sick.
It's not just one doctor, it'snow six experts in whatever
their area is who get to weighin on that.
Matt Burgess (43:46):
That's a yeah, you're going to get a better
answer now, I am someone whoquite likes a medical drama, um,
and in a lot of the sort of umdramas on tv they talk about
doing things, stat and you knowlike we need, um, you know,
information immediately and sortof one of the jokes in genetics
(44:08):
is nothing is ever really thaturgent.
You know, like in in emergency,if you need something straight
away, like seconds can make abig difference, whereas in
genetics, like really it's kindof like maybe days or, you know,
weeks or whatever.
But one of my um sort offavourite stories about you is
(44:28):
when you were requested by acardiologist because he needed a
genetics consult staff.
Can you tell us about that andsort of what happened and what
he needed you for?
Laura Yeates (44:42):
Yeah, sure.
So I mean I got a call to cometo the ward, which often
happened, you know, there'd be agenetic diagnosis or something
and they'd want me to come upand see the patient and give
them some education and helpsort out appointments or
organize genetic testing.
But this particular time one ofmy cardiologist colleagues, who
(45:04):
I knew she'd done some researchwith us, told me the story that
this cardiologist we had alovely patient and her family in
she was quite unwell, had comefrom overseas but couldn't, and
so didn't, speak much English,and so they were trying to take
a family history with theinterpreter, but there was
multiple consanguinity loops andso no one could work it out.
(45:26):
And so when I they're like'relike, oh, they need you to come,
like now, like right away, likeI think they're like we've
booked the, we've told theinterpreter to come back at like
12 o'clock, and it was like 11,15 or something, um, we need,
can you come at 12?
And and so I was like, yeah,yeah, I can come, um.
And so I got up there andthey'd managed to do that, that
this couple were married and hadsome children, and that was
(45:49):
about it.
So, I started again and itactually it was a hard.
It was a hard family tree.
You know it took me an hour anda half with the husband, um to,
and the interpreter, just tomake sure you know that we had
really got those relationshipsdown and there were multiple
consanguinity loops.
So I drew it up and put it inthe file, got those
relationships down and therewere multiple consanguinity
loops.
So I drew it up and put it inthe file.
But my colleague had told melater she was like I was
(46:10):
specifically asked that the youknow, the cardiologist kind of
yelled to the team.
Can someone please call LauraYates to come and take this
family history?
I don't know what's going on andso, like, at that point, you
know I had it's probably I, Idon't know, I was probably three
or four years into the job andso I'd worked really hard to
(46:31):
make sure I was at, you know,the weekly cardiology
departmental meetings I had anytime I was asked to consult on
the ward, or like one of thedoctors needed something, I
would try and do it straightaway, like really prioritize
them, like letting them know whoI was and the value that a
genetic counselor could have andhow I could help them.
(46:51):
And that was kind of when I knewI'm like, oh, if he's asking
for me, he knows what one, heknows what I can help with and
two, he values my input, yeah.
And so then we were joking thatlike I was needed stat.
It was very funny, it's likelike, and I kind of had to drop
everything no more clinic break,no, no, get up there and do it.
But it was just reallyvalidating for me that like, yes
(47:13):
, it had taken a long time togain this recognition, cause you
know, this is around like thiswould have been sort of 2010,.
2012 maybe.
So things were really startingto take off in in genetic text,
testing, wise and things.
So, yeah, it was just reallyvalidating for me that they
understood who I was and what Icould offer well done.
Matt Burgess (47:37):
I love that story, I think it's fantastic and but
it sort of highlights somethingas well.
You know, um in uh, our culturein Australia.
It's not often for some of usor most of us, when we're
drawing family trees to comeacross consanguinity and that's
the idea that our clients or thepeople that we're drawing on
(48:00):
the family tree may be relatedlike first cousins or second
cousins.
But I know sort of what makesit harder is when there are
multiple consanguineousrelationships in in the one
family tree.
It's like, oh okay, this iscomplicated and yeah, and just
trying to, you know, connect.
Laura Yeates (48:18):
So dad is your mom's, brother's, you know, like
, how, the, how the loop goes,because that's important just to
understand what might be goingon.
Genetically, um, each family isunique and I celebrate each and
every family that I talk about,like whether it's someone who
has, is adopted out and has nocontact, versus people who can
go six generations back.
(48:39):
Each family is unique and andbeautiful in whatever family
looks like for them.
Um, but, um, yeah, the, theconsanguinity loops.
It takes a little while to getright and it's important that we
get it right because we usethis information to assess risk.
Matt Burgess (48:53):
Yeah, and it's very interesting that you know
like one of the core sort ofcompetencies of a genetic
counsellor is drawing a familytree.
You know it's sort of you know,one of the the most basic or
one of the first things that welearn.
But it's interesting to thinkabout how it is a skill and that
(49:15):
we get better the more that wedo it.
And, um, I'm just curious, Idon't think I've seen one of
your hand-drawn pedigrees.
I know myself I'm not theneatest of people and what I
normally do is draw a familytree by hand and you know you
never know sort of where on thepage to put someone because
(49:37):
there might be more family andyou have to squash people in.
And then I sort of enjoy havingmy draft messy copy and then
doing a nice neat copy thatpeople can sort of read and
interpret, and whether that'sagain by hand or, you know,
using a program like TrackGene,who is a beautiful sponsor of
(49:58):
this podcast.
Thank you, trackgene.
Yeah, what do you think aboutsort of those basic genetic
counseling skills and sort ofthe importance of of?
Um, you know, practice and thatsort of thing?
Laura Yeates (50:11):
oh yeah, I mean, um, I, I am like you.
I draw a messy one and thenmake it presentable.
Um, because you're right, youalways put the person on the
wrong side of the page and thenthey've got like 10 siblings and
you put the other person withall this space who has like one
sibling.
You know it's crazy, um, Ithink for me, and something I
say a lot to the students and tothe new grads, is, you learn a
(50:36):
lot in your practice.
So I remember being in aconsult once with this lady who
we thought had arrhythmogenicright ventricular cardiomyopathy
, um ARVC, and I had taken herfamily history over the phone
before she came in.
And then she's in there withthe cardiologist and me and
we're giving her education aboutthe condition and she's like,
oh, after we got off the phone,I do have two siblings who died.
(50:58):
Did you need to know that?
And like, oh, they died intheir 30s.
And I was like I'm like yes, weneeded to know that.
And my boss looks at me likewhy?
Why am I paying you?
Like this is what, this is yourbread and butter.
And then I had reflected backand I clearly just didn't ask
the question in a way you know,I think I asked how many
siblings does she have?
(51:19):
But I didn't clarify wherethey're living or had passed
away or how many total werethere in your, how many children
were in your generation, inyour family.
And so you know from that it'slike okay, well, every pedigree
I did.
After that point I only madethat mistake once, right.
You then change your practiceand so I think you know you
learn something in the firsthundred pedigrees, the first 500
(51:40):
, the first thousand.
You can't rush that Like.
I feel like particularly andall due respect to the new
generation, they are lovely andthey have lots to teach me.
But one of the things I like toteach them is like don't try
and rush.
You know there's this urgencyto to get up the ranks and be
more senior genetic counselor.
Actually, you'll never have thegrace and the like, the support
(52:04):
in those early years again tolearn your craft and learn it
well.
So take that time, ask thequestions.
Don't be afraid that peoplethink you don't know because
you're a new grad, you're notmeant to know everything.
Just use that time and youcan't.
You know, I always say youcan't.
Just there's no shortcut to getto a thousand pedigrees.
(52:27):
You have to draw each and everyone, and so that practice will
change.
And then once you get to athousand, then we're going for
ten thousand.
But whatever it is, you know,just keep, that's okay, and
don't.
There is beauty in that and youlearn a lot from that process.
So don't, just, don't be tooquick to rush it.
I guess is my another one.
Matt Burgess (52:47):
Oh, I love your rants.
You sound so wise.
Oh, I don't know where thatcame from and I guess just
finally, you know thinking aboutstudents and a major theme in
genetic counselling iscertification, and you know we
have a certification processwhich is different to that in
(53:11):
the United States, which is moreof like a, a one-off exam,
which is different to what thegenetic counsellors do in the UK
.
What advice do you give um, youknow the the newer genetic
counsellors about certification?
Laura Yeates (53:35):
I say just do it Like yes, it's hard, it's hard
when you're working full time tothen be able to pull out your
computer on the weekend andwrite your cases.
But for me, it made me a bettergenetic counsellor.
Reflecting, working, looking atthe literature, what you know,
what theories can we use.
It made me a better geneticcounsellor, and I think genetic
counsellors um are the type buttend to be according to um
(53:58):
Robert Rester.
He wrote a blog post about howwe tend to be type A's.
So we, we want to do better, um, and so I think you know this
is part of it, and so I you knowmy advice is just break it down
, work.
Okay, I've got a couple ofhours now.
What am I going to work on?
I'll do my genetic section.
(54:19):
I'll do my transcribing of myrecorded case, whatever it is,
um, but just, although it's hard, enjoy the process because it
will make you better and weshould be better, because again,
it comes back to that wantingto keep learning.
Because you know when I started, the things that we do we do
now, like I can send for agenome testing.
(54:40):
Genome testing didn't exist whenI went through the course.
This is a profession.
If you don't like learning,you're in the wrong dog, because
the technology that we're goingto be using in 10 years hasn't
been invented yet.
Right, like so, um, yeah, Ijust think certification is a
particularly for your counselingskills is just a really
important process.
(55:01):
Um, so I, my biggest suggestionis to get a um, to get a like
good power ballad and just playthat on repeat.
Mine was Katy Perry raw andlike seriously, it got me
through.
Yeah, as I'm walking around,it's like, yeah, I've got this.
Like yeah, you're roaring, I'mroaring, yeah, especially when I
(55:24):
had to go in to do the umsession with the actor where the
board are watching.
Yeah, it's pretty intimidating.
I think they changed that now,but um, yeah, that was on repeat
for me oh good, I know I.
Matt Burgess (55:38):
You know Robert Rester's blogs and basically
everything he's written aboutgenetic counseling is amazing.
I am sort of the absoluteopposite of type A personality.
I'm very much type B, however,you know.
I guess we do in life, what'simportant to us or what gives us
(55:59):
meaning.
And I know I feel like a bignerd saying this, but I put so
much um importance on mycertification and it's still one
of the the proudest things I'vedone.
And I think on paper there areother things you know, like a
master's degree is probablyharder or better, or you know um
(56:22):
, than certification, but still,I still remember when I got my
letter saying you know,congratulations, you're now
board certified, like it was.
It was such an important moment.
So, yeah, I really hope thatthe newer genetic counselors
come that are coming throughsort of think about that and
appreciate that as well.
Laura Yeates (56:43):
Yeah, and it just.
It also just opens up aconversation.
Like you know, we would oftenpresent a case we were going to
write up in our supervisiongroup.
So then again you get moreinput.
You know, if you've got a fewgenetic counselors who've been
before you, would they read yourcase?
You know just ways that you canhelp get and you learn again.
You learn from the peoplewho've been before you and
(57:05):
sometimes and you can and thenhopefully you learn something
that you can apply to yourpractice.
Like I just think it's actually, although it's hard, is really
a valuable thing to do.
Excellent, it's easy to saythis side of it, it's like the
PhD.
You know, if you'd asked me thistime last year about a PhD,
when I was madly writing anddrowning, then yeah, you
(57:28):
might've got a different answer.
But this side of PhD, this sideof certification, life is good.
Matt Burgess (57:33):
Well, Dr Laura, thank you so much for chatting
to me about all things geneticsand genetic counseling.
I've really enjoyed it.
Laura Yeates (57:40):
My pleasure.
Thanks for all you do.
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Therapy Gecko
An unlicensed lizard psychologist travels the universe talking to strangers about absolutely nothing. TO CALL THE GECKO: follow me on https://www.twitch.tv/lyleforever to get a notification for when I am taking calls. I am usually live Mondays, Wednesdays, and Fridays but lately a lot of other times too. I am a gecko.