To change is to be human. To fear change is also to be human.
The website has changed. Whereas before it was mostly musings, it now is mostly photos. Although more musings may occur from time to time as well.
My own life has changed. I am departed on a new journey into new medicine and a new city.
I hope that you enjoy the updated website and the updated journey that I’ll be on. Until next, here are some of my favourite pictures that I’ve taken and uploaded to the site:
As of last Friday, I finished my Family Medicine rotation. In my opening thoughts about it posted previously, I mentioned how I loved exploring the therapeutic relationship, forming bonds of trust with patients, and having to know a little bit of everything. Throughout the 6 weeks, I would say that these were definitely the core concepts I encountered. As said before, I definitely did enjoy them.
However, I encountered much more than these core concepts as well. An interesting part of family medicine is that you can ‘specialize’ within it, even though it is so broad. As examples of this, I spent a few shifts working within Emergency, I spent an evening working with a doctor at a Transhealth Clinic, and I spent a day shadowing at a Methadone Clinic.
So, at a tertiary care centre (a big ass hospital), most of the doctors you will encounter in an ER are Emergency Medicine doctors, which is another type of specialty. In a smaller centre, you may have some ER doctors, but you will also have family doctors who either have extra training in Emergency, or have spent enough time working in the ER that they are considered qualified for it.
Long story short, I loved my shifts on ER. It is an entirely different experience compared to clinic. In general, the problems are much more acute, they require fast-ish follow-up and treatment, and you often get to send people home within a few hours. I loved the adrenaline rush of this. Also, strangely, I found that the fact that the patients were around for hours actually gave me more of a sense of connection to them then I sometimes got from clinic, in which 20 minutes was my average. I am definitely looking forward to my Emergency Medicine rotation after these encounters.
Another exposure I had was to Addictions Medicine. Now, it is important to note for both this one and the Transhealth clinic that within the scope of the clinic, the physician is not serving as the client’s family doctor. This is due to the funding model of both of these clinics. Never-the-less, it is a family doctor who is serving these roles.
To put it simply, for both the Addiction Clinic clients, and the Transhealth Clinic clients, there is a lot that I could say. And a lot I will say in future blog posts. Although very very different in nature, both of these populations are generally down-trodden, judged, and forced to live on the outskirts of society. As you can guess, being treated this way is not good for your health. If we truly wish to progress as a society, then it is those who we force down that we must focus on helping. But that is a story for another time.
One of my initial complaints about the rotation had been the simple fact that it wasn’t quite accurate in terms of how actual family medicine feels. When I watched a patient come in and talk to my preceptor, the doctor already knew that patient’s medical history, social history, etc etc. This was something that was impossible to emulate, as it only comes with time and familiarity.
Well, because of the 6-week nature of the rotation, I did get to follow-up with a few patients throughout. To put it simply, it feels rewarding to actually remember a patient from before, and to continue talking to them about their ongoing medical problems, and life in general. This part of family medicine is definitely something that appeals to me.
So, scattered thoughts need to be summarize. My final thoughts on Family Medicine:
1) Family Medicine is awesome.
2) I absolutely love the long-term thereapeutic relationship that comes with family medicine.
3) The ability to sub-specialize into different aspects of family medicine allows you to practice medicine as you want, and really seems to breath new life into your practice as well.
4) Family Medicine is definitely not crossed off of my list. If anything, it is now ranked very high up there.
And now, onto my psychiatry rotation.
If there is one thing that I have learnt in my 24 years upon this Earth, it is this: Never trivialize another’s pain. Never act like it is less than it is, never dismiss it, and never ignore it. Pain can be crippling, life-destroying, and can suck the joy out of life.
Despite this, sometimes doctors (and medical students, and members of the healthcare team) have no choice but to inflict pain upon those we’re supposed to be healing and helping. Vaccinations require the pain of the needle to protect from future illness. Painkillers may be withheld if the risk of addiction is too high. And sometimes, bad news must be shared.
The other day, I had to hurt somebody. I had to give them some bad news. And to be completely honest, (language warning) I feel like I fucked up.
It had already been a long day. A number of complicated patients had already come through, with numerous problems, presentations, and plans made for them. My mental feet were beginning to drag. Worse, my emotional feet were getting tired. A new patient was sent to my room. I introduced myself as usual, explaining that I was a medical student, that my preceptor would come in to talk to them after, and what could I help them with today? They were in to get some test results. And well… the test results weren’t good.
If I could have re-done this, the major change would have been right here. If I could re-do this (as I have 100 times in my head since), I would have left to get my preceptor. To this patient, I was a stranger. I did not have the same bond of trust that he had with my preceptor. But at the time, they wanted to know their results, which I had in front of me. I tried to prepare them, I tried to ready them for the bad news as I had been taught to in a class.
And then I dropped a bomb in their life. I told them. I hurt them. I caused them pain. At the same time, I could feel my own heart ripping from it.
Devastation. Have you ever seen true devastation upon another’s face? The type of devastation that causes a person to immediately deny what they were just told? I have, and it is not something that I can forget. What do you say in the face of something like that? What can you say?
All of my so-called training in ‘giving bad news’ was forgotten. Human to human, I tried to console them. I tried to apologize that they were put into the situation that they were. I tried my best to just be there for them. But I was a stranger, who had just given them bad news.
Finally, finally, I realized what I should have done from the start. I went to go and get their doctor. Together, the doctor and I went back in. Thankfully, I think that my preceptor was able to give back some hope to this patient. The doctor was able to come up with a plan to investigate and to help however we could. Some of the damage from the bad news was treated.
I think that my preceptor noticed that the encounter had left me exhausted and drained. They gave me a break, told me to go get some food and come back. I never told them how much that last encounter hurt, and they never told me that they could tell. And yet, somehow, I know that they knew. And I know that that is why they gave me that half hour.
So I went home. I thought about the encounter. I screamed into a pillow for a little while. I tried to take what lessons I could from it. I acknowledged the pain and sadness I was feeling, and that helped me. Not to overcome it, but to incorporate it.
I decided, then and there, that I want to do everything I can to minimize pain for patients who need to receive this bad news. I want to do everything I can to be there for them, and to try to help them retain hope.
I went back to the office after that break, and I saw more patients. I tried to help them with their problems. I tried to reduce their pain.
I tried, and am still trying, to learn what it is to be a doctor.
I’m 2 weeks into my rural family medicine rotation, and I am loving it so far.
For those of you unaware, family medicine is something in Canada that is similar but different than a general practitioner in most countries. Like a GP, they are the doctor that you will see for your check-ups, and at walk-in clinics. Unlike a GP, they have a large focus on prevention and are considered a ‘specialty’ as they do undergo additional training after obtaining their MD.
To explain it as simply as possible, Family Doctors specialize in illness prevention, harm reduction, and the therapeutic relationship. They get to know their patients, they form an ongoing doctor-patient relationship with their patients, and they use this relationship to either prevent their patients from getting sick (lifestyle advice, smoking cessation, etc), or to reduce the harm that might result from their patients getting sick (screening for disease early, or treating illness before patients become sick enough for the emergency room).
I love this aspect of family medicine. I love talking and forming that trust with people. I love learning about their lives and their context. I love being able to help them figure out ways to stay healthy or get healthy.
So what are my problems so far? Well, #1 would be that I am realizing how much I don’t know. And that sucks. Family Medicine is extremely broad in scope. It has “99 core topics”, ranging from abdominal pain to stroke to depression. To put it simply, there is a lot to know. You have to know a little bit of everything to be a good family doctor. And as this is my first rotation, I basically know a little bit of nothing. Or so it feels.
So I spend a lot of my time realizing how much I don’t know, looking up my knowledge gaps, then realizing that I still don’t know enough, rinse and repeat. That is my life right now. So it sucks but I feel like I’m constantly pushing and learning.
The other thing I’m struggling with is time management. Of course, I’ve been told that as a student, that is totally normal. They don’t care how long I take, as long as I get all the information. I understand this, but still… I wish I wasn’t quite as slow as I was.
And then there’s the situations that I just can’t help with. The complex social situations that you know is contributing to people’s health struggles, but simply seem to fall outside the scope of a family doctor. Things like poverty, racism, and cruelty. I can offer support, but how can I go about changing things like the structural poverty that many face? It’s extremely frustrating and sad. Obviously moreso for the person dealing with it, but unfortunately I can’t close my heart to things like that. It’s tiring and draining and so hard.
So, that is my first impression of Family Medicine. Definitely something to love, definitely something that I’m interested in doing. In a few weeks, I’ll post an update, since I have some exciting novel encounters coming up including shifts at the Emergency Room, TransHealth Clinic, and Addiction Clinic.
For those of you unaware, it is election time in Canada. For what feels like an eternity, our 3 main parties (the ‘left’ New Democrats, the ‘central’ Liberals, and the ‘right’ Conservatives) have been locked in battle, trying to win the votes and minds of Canadians. Currently, they’re busy arguing about what women (or womyn if you identify that way) should wear, and labeling other cultures as barbaric or not. Yeah, real glad that we extended our campaigns so that we could continue throwing stones in glass houses.
Now, as a medical student, I’ve always held the belief that I should be non-partisan, at least publically. Doctors, especially public health doctors (a field I eventually hope to transition into), must be able to work with the government, regardless of their own political beliefs. Also, partisanship is just generally a bad idea. Political parties are not your friends… they must be expected to continually earn your loyalty as they serve. A person should not blindly trust a politician… ever. The thing is, I’ve come to realize that medical students aren’t doctors (duh). We are a slightly more protected population. It would take a lot more effort for a medical student to burn all of their political bridges. To put it simply, we are in the place where we can advocate for what doctors might not be able to.
So, as a medical student, let me tell you some stories. Health policies matter. Health policies are important. They shape the way that we live our lives, and they shape the way that we interact with our health care system.
I want you to imagine a situation with me. Let’s imagine, just for a moment, that you happened to have a lot of illness. Your heart wasn’t quite working right anymore, you had Diabetes, etc etc. A lot of those illnesses have medications that can help to control the symptoms that you might get with those illnesses. A lot of them are necessary to live a functional and long life. But they are also really expensive. As you are all probably aware, we do not have extensive pharmacare in our country. So, what happens when you can’t afford those medications? Well, you don’t get to take them all, of course. You get to have the wonderful task of picking and choosing which ones you take (and hopefully, you have a doctor who can help you with this, or find loopholes to make sure that you are receiving this critical, life-saving medication). So basically, a doctor can diagnose and know that you have an illness, but because of a restricting health policy, they can’t actually treat you for it all of the time. That is a gigantic problem for everyone.
A physician named Rudolf Virchow once said “Politics is just medicine on a grand scale’. I would modify this, and say that Politics should just be medicine on a grand scale, but we tend to lose sight of that. Politics should be a system of organizing and caring for a population. Instead of talking about important points in governing ourselves, our political leaders are talking about their little hot topics… their distractions away from the true issues. They have not yet talked about pharmacare to any great degree. They have not yet discussed the mistreatment of our indigenous populations, or what they actually want to do with our healthcare system. What about senior care?
There are so many discussions that are not being had. It is incredibly important that we read what policies the parties are proposing, even if they aren’t talking about them.
So, I’ll say something that you’ve heard modify it, but then make it a little more controversial. Vote! Make your voice heard! But first… educate yourself. Do not blindly vote for a party. These parties will form our new government, this government will shape our health.
In the interest of educating yourselves, here are some resources:
It is the beginning of my next journey. After 2 long years of study and work (and 1 year of a sabbatical of volunteering and work), I am finally at the beginning of clerkship. Never before have I been so excited, nor so terrified. Terricited, if you will.
For those of you reading who may not be familiar with medical school terminology, ‘clerkship’ refers to the last 2 (or around 2) years of medical school in Canada where we assume clinical responsibility. Whereas the first two years is mostly theory with some clinical practice, the last two years is mostly clinical practice with application of that theory that we desperately learnt during the first two years.
For the first two years, the worst thing that can happen is that you fail an exam. The thing about that is that the consequences begin and end with you. If you fail an exam, then you re-write it, and learn that information that you might not have known well enough.
In clerkship, however, the consequences do not end with you. You are responsible for patient care. Although you should be getting overseen by somebody more responsible and knowledgable than yourself, mistakes can happen. Things can slip through the cracks. You can hurt somebody. That is terrifying beyond measure.
However, it is also so much closer to real medicine than the first two years. Finally, you are practicing and experiencing medicine. You can talk to patients, and help them cope, and maybe catch something that might have been missed. You can spend time with patients, and learn their stories, and be there for them. That is exciting beyond belief.
I begin my first rotation tomorrow. This is the beginning of my clerkship journey.
Now, before I leave, a disclaimer of what this new section of the blog will be, and more importantly, what it won’t be.
This will be a blog where I share my thoughts, my reflections, and my beliefs. This will NOT, however, be a blog that will contain ANY details of any patients, doctors, classmates, or anything else identifying of anybody I meet. The only exception to this will be if I have the absolute and ethical permission of those involved.
Hope you have fun reading.
For the past two weeks, we’ve been talking about Social Media, and the dangers of how it makes us feel. A brief summary of what we’ve talked about: A lot of us are addicted to Social Media. Using Social Media can make us feel inadequate about ourselves or jealous of others because 1) people only present their highlight reels as false masks of their lives and 2) we can’t help but compare our lives that we know the good and bad of to others lives that we can only see the good.
So far, I’ve been speaking about this experience as a one way street. They post, we read, we feel. Social Media is about connections, however. By its very nature, it cannot be one-way. We, too, can post and make others feel.
So, readers, what sorts of things do you tend to post about? Do you like to post about the mundane things? Or do you like to post about the super awesome things that other people should know about? Loaded questions aside, most of us will post more about awesome things than unawesome things. There is nothing wrong with that, it is entirely human to want to share the cool things that we do.
Like all things, there is a danger to that as well, however. It is one thing to post awesome things, it is quite another to begin living your life for the ability to post those things. Have you ever done something just so that you could post about it? Or less so, have you ever thought about how great it would be to share something while you were doing it?
When we put all of this emphasis on our online life being equal to others’ online lives, something else happens. We begin living for the likes and approval of others. We begin doing things just for the ability to post about it. Even worse, we begin taking ourselves out of the moment, in order to document it to post it later. I’ve found myself, so many times, stepping out of a situation, disengaging from an adventure or encounter, to take a picture of it. I mourn the loss of all of those engagements I might have had if I hadn’t of taken a picture of it.
This Social Media mindset can lead to us over-valuing the documenting of experiences instead of getting the experience.
So how do we fight against this encroachment, this lifestyle? I will not for a second pretend to have all the answers. I can share my own strategies, and hope that maybe you’ll find some value out of them. As always, I would encourage you to leave a comment on the page if you can think of anything I didn’t.
- Be aware. This is really a universal strategy for every type of behavior. Be aware of your choices and thoughts, and think about where they come from. Question your motivations!
- Take Social Media breaks. Even if just for a day at a time, give yourself a rest from Social Media. Forget your phone at home (depending on the type of job or lifestyle you have, this might not be an option). It’ll be scary at first, and then exhilarating.
- From time to time, put away your camera/phone. Try to take in the experience instead of documenting it. Listen to the band instead of filming them.
- When you’re talking to somebody, don’t fiddle with your phone. Keep it in your pocket. To be blunt and honest, this one is tough. I break this one all the time. It is a terrible habit and one that is so difficult to break. However, I’m not going to stop trying.
- Most importantly, try to remember that as perfect as somebody’s life may seem online, they have their own struggles and flaws. Nobody is perfect, and everybody is human.
You are awesome in your own way. Never forget that.
PS: There will not be a blog post next week, as once again, I have a Big Scary Exam (BSE) approaching.